Provider Handbook

The Provider Handbook outlines the ValueOptions^® standard policies and procedures for individual providers, affiliates, group practices, programs and facilities. Providers are encouraged to carefully review the Handbook as well as visit the Network-Specific page to verify which policies and procedures are applicable to them.

This handbook is an extension of the provider agreement and includes guidelines on doing business with ValueOptions^®, including policies and procedures for individual providers, affiliates, group practices, programs and facilities. Together, the provider agreement, addenda, and this handbook outline the requirements and procedures applicable to participating providers in the ValueOptions^® network(s). This handbook replaces in its entirety the previous version.

Questions, comments and suggestions regarding this handbook should be directed to ValueOptions^® at (800) 397-1630.

Please click below to launch the Provider Handbook and the Provider Handbook Appendices. You will need Adobe^® Reader to view the Handbook. If you do not have access to this software, you may download and install these applications on your computer.

ValueOptions^® Provider Handbook (PDF)

• Section 1.0 Overview
• Section 2.0 About ValueOptions^®
• Section 3.0 Credentialing & Re-Credentialing
• Section 4.0 Sanctions
• Section 5.0 Appeals of National Credentialing Committee (NCC)/Provider Appeals Committee (PAC) Decisions
• Section 6.0 Office Procedures
• Section 7.0 Services to Members
• Section 8.0 Participating Provider Complaints, Grievances & Appeals
• Section 9.0 Claims Procedures
• Section 10.0 Utilization Management
• Section 11.0 Appeal of Adverse Determinations
• Section 12.0 Quality Management/Quality Improvement

Appendices

• Appendix 1 Handbook Glossary (PDF)
• Appendix 2 List of Forms & Reference Documents
  
  • Clinical Criteria
  • Treatment Guidelines
  • Resource Documents
    
    • Member Rights (English) (PDF)
    • Member Rights (Spanish) (PDF)
    • EDI Resource Document – E-Support Services for ProviderConnect and Electronic Claims (PDF)
    • Provider Summary Voucher Form Sample (PDF)
    • CMS 1500 Claim Form (PDF)
    • Tips for Completing the CMS 1500 (PDF)
    • UB04 Claim (PDF)
    • Tips for Completing the UB04 (PDF)
    • Electronic Funds Transfer (PDF)
    • Electronic Provider Summary Vouchers (PSVs) (PDF)
    • Provider Guide to Online Authorizations (PDF)
    • Electronic Authorization Letters (PDF)
    • Clinical Department Hours of Operation (PDF)
  • Forms
    
    • Administrative
    • Clinical
    • EAP
• Appendix 3: State/Government Program/Network Specific Provision and/or Supplements
• Appendix 4: Medicare Advantage Specific Provisions (PDF)
• Appendix 5: EAP Handbook (PDF)
• Appendix 5A: MOS Handbook (PDF)

Provider Handbook Updates

• Provider Handbook Updates and Edits Log (PDF)

Important Notice

ValueOptions^® reserves the right to interpret and construe any terms or provisions in this Handbook and to amend it, at its sole discretion, at any time. To the extent that there is an inconsistency between the Handbook and the provider contract, ValueOptions^® reserves the right to interpret such inconsistency. ValueOptions'^® interpretation shall be final and binding.