- New ProviderConnect Enhancement: Update Provider Demographic Information
- ProviderConnect now Features Role-based Security
- Electronic Fund Transfer/PaySpan
- Electronic Provider Authorization Letters
- Submitting EAP CAF Through ProviderConnect
- New Clinical Criteria: Substance Use Laboratory Testing for Drug and Alcohol Use
- Clinical Document Submission Fax Number and Address Information
- Outpatient Detoxification Buprenorphine (Suboxone® or Subutex®) Maintenance Program
- CAQH® Provider Credentialing and Recredentialing Frequently Asked Questions
- Credentialing Criteria Change for Inpatient Pyschiatric Facilities
- DSM-5 FAQs and ProviderConnect Screen Guides
- ICD-10 Transition
- CPT Code Change Information
- Mental Health Parity and Addiction Act of 2008 - Final Rule
- HIPAA 5010
- Revised CMS 1500 Form (Version 02/12)
- Are you receiving important communications from ValueOptions?
- Are members able to reach you for referral purposes?
- Are manual processes like faxing paperwork and filling out forms by hand taking hours out of your day?
In just a few steps, network providers can submit real time demographic updates electronically via ProviderConnect. Electronically submit demographic updates today or you may fail to receive an important communication or referral opportunity.
ValueOptions has recently added a system enhancement to ProviderConnect, our secure provider portal, which allows providers to view and update their active service locations along with associated telephone and fax numbers, and billing locations.
To update demographic information, simply log into ProviderConnect and click on the “Update Demographic Information” link. Click the “Edit” icon that coincides with the information requiring updates.
Further instructions on this new enhancement are summarized in Section 18 of the ProviderConnect User Guide. If you have specific ProviderConnect questions or concerns, you can also call the EDI Help Desk at 888.247.9311 8 a.m. to 6 p.m. ET.
ValueOptions is pleased to introduce a new level of ProviderConnect access, role-based security, designed to enhance security measures for providers and ensure compliance with HIPAA regulations.
With this new enhancement, providers can:
- Create New Login Accounts
- Deactivate Login Accounts
- Control User Access to Certain Areas within ProviderConnect
Providers can now grant varying levels of functionality to employees within their office, so that only specific employees will have access to processes and information. For example, a provider may only want his/her accounts payable clerk to be able to process claims. Role-based security makes this possible.
Three types of user types are currently available:
- Manages other users’ login accounts
- Creates new login accounts and disables users
- Controls access to specific areas within ProviderConnect
Managed user (with rights managed by the super user)
- Managed by a superuser and only has access to functions to which he/she has been granted access
- Not managed by another user or manages other users
- Has access to certain areas of ProviderConnect depending on his/her assigned role
To begin using role-based security, contact the EDI Help Desk at 1-888-247-9311 from
8:00 am – 6:00 pm ET or by email at email@example.com.
For additional information on this enhancement, refer to the “Role-based Security” section in the ProviderConnect user guide.
PaySpan® Health is a tool that will enable you to:
- Receive payments automatically in the bank account of your choice
- Receive email notifications immediately upon payment
- View your remittance advice online
- Download an 835 file to use for auto-posting purposes
- Learn more about the benefits of PaySpan and how to obtain access.
Urine Laboratory testing for drugs or abuse is a key component in the initial assessment and ongoing monitoring of drug and alcohol treatment compliance. As a result of an increase in direct marketing by laboratory companies to providers for this type of testing, not only has there been a rise in the amount of testing being done, but there has also been a rise in fraud and abuse. To circumvent this issue, ValueOptions has recently developed medical necessity criteria to aid providers in drug testing decisions.
Providers need to be aware of the costs associated with urine drug tests and should thoughtfully review laboratory requests for blanket urine drug testing or standard provider specific testing. Since an individual urine laboratory drug analysis can be over $1600 per test, rationale for testing should be individualized, medically driven and have an effect on treatment decisions. Providers should be aware of the following criteria when determining the type of tests to be ordered and frequency:
- General Testing Guidance
Testing should only be ordered after the patient demonstrates symptoms consistent with a substance use disorder, after the evaluation of the patient by a licensed clinician. The type of tests ordered should be within the scope of the license of the ordering practitioner.
- Qualitative Testing
Qualitative, rapid screening tests for substance use disorders are recommended upon admission for substance use treatment. After admission, screenings are expected at a frequency of no more than 3 times every 30 days. Any further testing requires rationale documented in the medical record and must meet medical necessity.
- Quantitative Testing
Quantitative testing results rarely influence treatment decisions when patients self-disclose use when confronted with a positive qualitative test. If patient does not self-disclose, quantitative testing is authorized no more than 3 times every 30 days.
To learn more, refer to ValueOption's Medical Necessity Criteria 4.70 located on the Provider section of ValueOptions.com.
To learn more about ValueOption’s overall change in structure for substance use medical necessity criteria, which went into effect on January 1, 2013, refer to ValueOptions’ Frequently Asked Questions.
ValueOptions® has a single fax number and mailing address for out of network provider outpatient requests for service. ValueOptions in-network providers are expected to submit requests via ProviderConnect.
For inpatient or higher level of care requests for service, ValueOptions in-network providers should submit requests via ProviderConnect. Out of network providers can call the toll-free number on the back of the member’s identification card.
As there are exceptions to this process, please view the full announcement here.
Outpatient Detoxification Buprenorphine (Suboxone® or Subutex®) Maintenance Program ValueOptions is now offering a program to several of our clients called the Outpatient Detoxification/Buprenorphine (Suboxone® or Subutex®) Maintenance Program. ValueOptions feels this program is necessary to help the estimated several million individuals who are suffering from abusing prescription medications and other opioids throughout our nation. To learn more about the Outpatient Detoxification Buprenorphine (Suboxone® or Subutex®) Maintenance Program please reference the materials below:
At their annual meeting in May 2013, the American Psychiatric Association (APA) released the new DSM-5. This is the first update in almost 20 years since DSM-IV was released. Refer to the ValueOptions® DSM-5 Frequently Asked Questions document for further information about DSM-5.
- DSM-5 and ICD Codes – What is the relationship?
- DSM-5 Frequently Asked Questions
- Prior to June 28, 2014 – ProviderConnect DSM-5 Screen Accommodations Guide
- After June 28, 2014 – ProviderConnect DSM-5 Screen Modifications Guide
On April 1, 2014, the President signed into law legislation passed by the House and Senate delaying ICD-10. The Centers for Medicare and Medicaid Services (CMS) has announced the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10 is October 1, 2015.
For more information, refer to ValueOptions’ ICD-10 Frequently Asked Questions (PDF)
For additional training options see our Webinar Calendar
- 2015 ICD-10 Provider Overview Presentation Slides (PDF)
- 2015 ICD-10 Provider Overview Recording (WMV)
- ICD-10 Transition: Q&A Session (PDF)
- ICD-10 Transition: Q&A Session Recording (WMV)
- Using DSM-5 in the Transition to ICD-10
- CMS ICD-10 Code Lookup
- Coding Conversion Tool
- CMS ICD-10 website
- Road to 10
- Press Release: "CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10"
- Get the ABCs and Get Ready Now!
Annually in October, the American Medical Association defines and releases a new set of Current Procedural Terminology (CPT®) codes. This new code set took effect on January 1, 2013. Treatment providers use these CPT codes when submitting claims for services provided to their patients. The 2013 code set included many changes that impact provider billing. Many codes were either deleted or modified.
To assist providers in complying with the new set of Current Procedural Terminology (CPT®) codes which took effect on January 1, 2013, ValueOptions is continuing outreach efforts to assist providers with 2013 date of service claims denied due to incorrect code usage. In addition, the following resources were made available on the ValueOptions Provider Website:
- 2013 CPT Code Changes Frequently Asked Questions (PDF)
- 2013 CPT Code Changes Presentation Slides (PDF)
- 2013 CPT Code Changes Webinar Recording
- 2013 CPT Code Crosswalk (PDF)
- Tip Sheet for Submitting 2013 CPT Codes (PDF)
Updated fee schedules have also been distributed and reflect the new CPT® codes or HCPCS® codes/ rates for those services. Providers who participate in more than one provider network through ValueOptions, may have received additional communications with network specific fee schedules. If you have additional questions about the 2013 CPT code changes, please email us at firstname.lastname@example.org.
ValueOptions® has made the necessary changes to comply with the modifications to HIPAA Electronic Transaction Standards. Version 4010 standards were replaced with Version 5010 standards on January 1, 2012. Effective June 30, 2012, ValueOptions no longer accepts HIPAA 4010 files.
To effectively accommodate and implement ICD-10-CM diagnosis codes, the National Uniform Claim Committee (NUCC) has revised the CMS 1500 paper claim form. Beginning April 1, 2014, Centers for Medicare & Medicaid Services (CMS) will only accept claims submitted on the revised CMS 1500 paper form (version 02/12).
To assist providers with the transition, ValueOptions® will continue to accept both versions of the paper form until May 31, 2014. Beginning June 1, 2014, ValueOptions will only accept claims submitted on the revised CMS 1500 paper claim form (version 02/12).
A sample version of the CMS paper claim form (version 02/12) is available on the handbook section of our website. Providers can also visit the NUCC website to learn more about the revised form and where it can be purchased.
Opioid addiction continues to be a growing public health problem with significant medical and financial ramifications. Opioid addiction, along with other drug addiction, is now viewed as a chronic disease, requiring an evidenced based recovery management approach to increase the likelihood of sustained recovery. The American Society of Addiction Medicine (ASAM) has developed the National Practice Guideline to provide information on evidence-based treatment of opioid use disorder. This guideline is the first to address all the FDA-approved medications available to treat addiction involving opioid use and opioid overdose. It was developed to assist physicians or other prescribing professionals in the decision-making process for prescribing pharmacotherapies to patients with opioid use disorder. The intent is to educate, promote safe and quality prescribing, and promote quality treatment and recovery practices.
This ASAM Practice Guideline is intended to aid clinicians in their clinical decision-making and patient management. The Practice Guideline strives to identify and define clinical decision-making junctures that meet the needs of most patients in most circumstances. Prescribing physicians are encouraged to continue their medical education regarding evidence-based treatment of opioid use disorder and to continue training and consultations with certified specialist. Below is an outline of topics reviewed in the ASAM National Practice Guideline:
- Assessment and diagnosis of opioid use disorder
- Treatment options
- Treating opioid withdrawal
- Psychosocial treatment in conjunction with medications for the treatment of opioid use disorder
- Special populations: Pregnant women
- Special populations: Individuals with pain
- Special populations: Adolescents
- Special populations: Individuals with co-occurring psychiatric disorders
- Special populations: Individuals in the criminal justice system
- Naloxone for the treatment of opioid overdose
ASAM offers a pocket guide, phone and tablet apps, a PowerPoint presentation, webinars, tool kits and more.
For more information, visit http://www.asam.org/practice-support/guidelines-and-consensus-documents/npg for a complete guideline and related products. The Beacon Health Options Provider Handbook includes our company’s adopted Clinical Criteria and Treatment Guidelines.
Network providers with Beacon Health Options, Inc. (Beacon), formerly known as ValueOptions, Inc., are encouraged to utilize the Council for Affordable Quality Healthcare (CAQH) ProView™ online Universal Provider Datasource® (UPD) for demographic updates and recredentialing purposes. In addition, new providers eligible to join the Beacon provider network may use CAQH's UPD for the initial provider credentialing process. CAQH offers providers a rapid and simple solution to securely submit credentialing information to multiple health plans.
ValueOptions’ recently updated the credentialing criteria for inpatient psychiatric programs to better align its credentialing criteria with existing clinical medical necessity criteria for acute inpatient mental health programs.
Effective January 1, 2014, the Empire Plan Mental Health and Substance Abuse Program will be administered by ValueOptions®.
As a ValueOptions in-network provider, you are eligible to receive referrals and provide services for this population. Providers should confirm network participation prior to seeing an Empire Plan member. If you are concerned about your participation status, contact the Provider Services line at 800.235.3149.
Providers with Empire Plan members in active treatment should continue to submit authorization requests to the current carrier through December 31, 2013. After January 1, 2014, providers will be required to submit continued authorization requests to ValueOptions. Additional information is available in the Empire Plan Provider Frequently Asked Questions Document (FAQ).
We recognize that it is only through exceptional professionals like you that we can make high quality behavioral health care more accessible to our members. In order to keep providers informed, ValueOptions has included resources on www.valueoptions.com.
- Provider website, specific to the Empire Plan
- Empire Plan Provider FAQ
- January Educational Webinar Invite
- ProviderConnect®, our secure, HIPAA-compliant website that enables participating ValueOptions network providers to conduct online claims and authorization transactions accurately and efficiently.
If you have any questions or need assistance, please feel free to call the Provider Services Line at 800.235.3149 between 8 a.m. and 5 p.m. ET, Monday through Friday. A Provider Network Representative will be available to assist you with any questions. After January 1, 2014, the Provider Services Line hours will change to 8.a.m. to 8 p.m. ET.
The ValueOptions On Track program is a client-centered outcomes informed care program designed to provide clinicians with state of the art, easy-to-use tools that promote improved client outcomes. ValueOptions clinicians may use On Track for all of their EAP, commercially insured or private pay clients, including, if they choose, those clients who are not ValueOptions members.
Individual clinicians with access to the ProviderConnect web portal can access the On Track tools. The first time providers use On Track, they will be asked to confirm key information used by the program before being connected to the On Track forms and tools.
Group practices and group practice administrators will not be able to access On Track through ProviderConnect and should send an email to OnTrackOutcomes@valueoptions.com for information about how to begin using On Track.
The ValueSelect Outpatient Program is an exclusive program designed to recognize network outpatient providers who are engaging in activities that promote clinical effectiveness, member access to services, member satisfaction, and administrative efficiency.
As a member of the ValueSelect program, providers are eligible to receive:
- Opportunity for increased referrals
- Free CEU/CMEs through Relias Learning
- Training Discounts through Behavioral Tech, LLC
- Access to Achieve Solutions, ValueOptions award-winning website that offers valuable mental health resources, assessment tools and articles that may be shared with clients
To qualify for the ValueSelect designation, providers must demonstrate the following:
- Accessibility: Seeing five or more ValueOptions members (EAP and non-EAP) in the past 12 months (or at least 10 commercial members for clinics);
- Administrative efficiency: conducting transactions using ValueOptions ProviderConnect portal within the past 12 months, and
- ValueSelect Activities: Engaging in one or more of the following activities
- Participation in the On Track Outcomes Program
- Submitting at least 75% of non-EAP claims electronically
- Having clients complete the ValueOptions® Patient Treatment Survey
- Having a CEAP credential
To learn more about this program, refer to the ValueSelect Outpatient Program Description or contact your Provider Relations representative.
ValueOptions currently has openings within our National Credentialing Committee (NCC) and Provider Stakeholder Committee (PSC).
The NCC is comprised of representatives of major clinical disciplines, participating providers and representatives of engagement center and corporate departments including national network management, provider relations, quality management and clinical services. Responsibilities of the NCC include providing oversight, meaningful advice, recommendations on policy, and decisions regarding credentialing, recredentialing and provider sanctions using a peer review process.
The Provider Stakeholder Committee is a forum for committee members to provide input on ValueOptions’ Utilization Management and Quality Management programs.
Openings are also available on many of our clients’ committees nationwide.
If you are interested in potentially serving on one or more of these committees, please e-mail us at email@example.com.
It is tax season! ValueOptions® will be mailing 1099’s no later than January 31, 2014. 1099s are only issued for providers who were issued total payments of $600 or greater in 2013.
In order to answer questions regarding your 1099, ValueOptions has set up a specific 1099 Hotline. Please call 703.390.4936. This is a voicemail box that is monitored by our Finance Department. All calls will be returned within 3 business days.