ValueAdded

This is the 174th issue of our VBH-PA information update. These updates will be emailed to all network providers monthly. Please feel free to share our newsletter with others, and be sure your appropriate clinical and financial staffs receive copies.

Insidethisissue

 POS Changes ......................        2  Missed Appointments  .......        2  Claims for Methadone  Assisted Treatment ............      3  A Fond Farewell  .................        3  Website Updates ................        4  14th Annual Consumer  Forum………………………….....        4  6th Annual NW3 Forum Proves a Great Success! .....        5  Five Things Physicians and Pa ents Should Ques on  ..        6  WPIC Videoconferences .....        7  

Vol.15Issue12December2013

New 2014 Electronic Claim Submission Requirements

For the majority of 2013, ValueOptions® has strived to communicate the importance of electronic claim submission to our provider network. With 2014 quickly approaching, ValueOptions will soon begin making electronic claim sub-mission mandatory for new and existing providers through our recommended platform, ProviderConnect, or through other claim submission vendors.

By January 1, 2015, existing providers will be required to submit all claims electronically. For new providers with a contract date on or after April 1, 2014, electronic claim submission will be required at the time they join ValueOptions. However, small practices as defined by the Center for Medicaid Services may file an exception request.

Additional information regarding this change will be communicated to providers in the coming weeks and months, and will reference training opportunities, incentive offerings and more details regarding this new requirement.

Original ar cle can be found in the  Valued Provider eNewsle er from ValueOp ons: 

h p://www.valueop ons.com/providers/News/The_Valued_Provider/2013/Provider‐eNews‐November‐2013.pdf  

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ValueAdded—December 2013 

Missed Appointments

Per the December 1, 2010 Pennsylvania Medical Assistance Bulletin, Number 99-10-14, subject “Missed Appointments”:

The Centers for Medicare and Medicaid Services (CMS), which is responsible for administering the Medicaid Program, has an existing policy that prohibits MA providers from billing recipients or the Medicaid agency for missed appointments. According to CMS, a missed appointment is not a distinct reimbursable Medicaid service, but a part of the provider’s overall cost of doing business. As such, it is included in the MA rate and providers may not impose separate charges on Medicaid recipients. State Medicaid programs, including Pennsylvania’s MA Program, must comply with the CMS

Place of Service (POS) Changes

Please be advised that Value Behavioral Health will be updating the POS codes on the provider covered services grid effective January 1, 2014. A new service class grid will be posted on www.vbh-pa.com later this month with the new POS codes. You may view the grid on our website on the Provider Information page under the Provider Relations section, or click here for the direct link to ensure you are using the correct POS codes. Listed below are the valid POS codes and their descriptions.

POS Place of Service Description  POS 

Place of Service Description 

03  School  49  Independent Clinic 

11  Office  50 Federally Qualified Health Ctr 

12  Home  52  Psychiatric Facility - PH 

15  Mobile Unit  54  ICF/MR 

21  Inpatient Hospital  56  Psychiatric RTF 

22  Outpatient Hospital  57 Non-Residential Substance Abuse Treatment Fac 

23 Emergency Room - Hospital  65 

End-Stage Renal Disease Treatment Facility 

24 Ambulatory Surgical Center  72  Rural Health Clinic 

31  Skilled Nursing Facility  81  Independent Laboratory 

32  Nursing Facility  99  Other POS 

policy on this subject; therefore, MA enrolled providers who render service to MA recipients may not bill recipients for missed appointments.

MA providers may not bill MA recipients enrolled in the FFA or managed care delivery system (HealthChoices and voluntary managed care plans) for missed appointments. Additionally, MA payment is not available for any charges related to missed appointments, as no covered service was rendered.

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ValueAdded—December 2013 

A Fond Farewell For those of you who have not yet been made aware, Laverne Cichon resigned from her position as Service Center Vice President at Value Behavioral Health of PA. Her last day was November 29, 2013. She is very grateful for the opportunity to work with everyone over the past twelve years. In the interim, Mark Fuller, MD, VP and Regional Medical Director, will assume the duties of the day-to-day operations. Mary Mastrandrea, Senior Vice President of Public Sector, ValueOptions, Inc., will also be available as a resource during this time of transition. We all at Value Behavioral Health wish Laverne continued success in her future endeavors. She will be greatly missed.

Claims for Methadone Assisted Treatment

Claims for Methadone Assisted Treatment should be submitted after the billable

service encounter takes place. Therefore, a provider that uses a weekly service code (T1015 + applicable modifier) should wait to bill this code until the week in which the service takes place has ended. This is based on a seven-day calendar week, beginning on Sunday and ending on Saturday. The Methadone Assisted Treatment Provider cannot bill the weekly rate for a member if there are three or fewer encounters during the seven-day calendar week (MA#28-00-03).

If the Methadone Assisted Treatment Provider bills for a member on a daily basis (service code H0020 + applicable modifier), the claim may be billed after the service is rendered. Here are a two examples: 1) A patient receives a service encounter (dosing, counseling, etc.) on Monday, Tuesday, Thursday, and Friday. The program may bill the weekly code (T1015 + applicable modifier) on Sunday or thereafter. 2) A patient presents at the clinic for take-home bottles on Wednesday. As early as the next Sunday, the program may bill the daily rate for the Wednesday encounter (H0020 + applicable modifier) of the previous week.

Welcome!

Lisa Kugler, Psy.D., is the new VP of Clinical Services. Lisa comes to VBH-PA with a wealth of direct practice experience leading clinical programs at the Veterans Health Administration. Brad Eckels, LPC started on November 4th as a Compliance Auditor. Brad comes to VBH-PA from Family Services, where he was a school-based outpatient therapist.

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ValueAdded—December 2013 

WEBSITEUPDATES

Look for this column in our monthly newsletter for information recently posted to www.vbh-pa.com. 2012 RTF Provider

Profile Report Provider Profiling Reports

14th Annual Consumer

Recovery Information http://www.vbh-pa.com/

Requests for Proposals: Westmoreland County

Extended Acute Care Services

Washington County Substance Abuse Outpatient Treatment Services for Washington County Youth (Leader Program)

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Save the Date Value Behavioral Health of 

Pennsylvania   Presents the

14thAnnual Consumer Recovery Forum

Friday, April 4, 2014 

Pittsburgh Marriott North  

Cranberry Township 

We are currently accepting exhibitor registrations and nominations 

for the Leadership in Recovery Awards.  Nominate an outstanding 

individual from your county today!  Visit our homepage at  www.vbh‐

pa.com for the registration and nomination forms.  General 

registration for the forum will also be posted there, so check back 

often! 

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ValueAdded—December 2013 

The 6th Annual VBH-PA NW3 H e a l t h C h o i c e s M e m b e r “Acknowledging the Journey” Behavioral Health Forum was held November 14th at the Park Inn by Radisson in West Middlesex, PA. The forum proved to be another successful event with over 200 people attending, including over 55% being VBH-PA adult consumers or family or friends of child & adolescent members. Twenty-five exhibitors presented valuable education, program information and free give-a-ways to attendees.

The event’s evaluations continue to indicate that the audience truly enjoys coming, learning and being inspired by speakers and award

winners’ stories of recovery and resiliency.

Audrey Smith and Harry Nelson delivered information on trauma, anxiety and panic disorder; Patricia Lemer spoke on addressing the causes of behavioral disorders—not masking the symptoms; Clarence Jordan, ValueOptions VP of Wellness and Recovery, inspired many on their road to recovery as he presented “The Very Short Long Road Home: Life Stressors and the Returning Warrior”; Shelley Bishop ended the day with her shared life experience and presentation on “I’m the Evidence” mental health campaign.

6th Annual “Acknowledging the Journey” O n c e a g a i n t h e m o s t

commented on part of the day was the Exceptional Individual and Parent & Grandparent Award Ceremony! Stories of struggles, hard times and challenges overcome by hope, wellness, recovery and success truly touched the lives of all of us in the ballroom at the Park Inn.

The following award winners’

stories were told and their successes were shared. Congratulations to all winners for excelling on their journeys.

CRAWFORD COUNTY

Michelle Dragosavac, Exceptional Individual, nominated by Journey Center at CHAPS. Melony McCoy, Exceptional Parent nominated by Joyce Klasen.

MERCER COUNTY Douglas Hovis , Except ional Individual, nominated by Mercer C o u n t y B e h a v i o r a l H e a l t h Commission. Carol McVehil,

Exceptional Grandparent, nominated by Vocational & Psychological Service’s Musser Tiger SCORE Program.

VENANGO COUNTY Donna King, Exceptional Individual, nominated by Community Voices in Oil City. Christine Aue, Exceptional Grandparent, nominated by Venango County MH/DS.

A special thank you to Laverne Cichon, VBH-PA CEO; Dr. Mark Fuller, VBH-PA Medical Director; and Valerie Vicari, Director, Office of Mental Health and Substance Abuse (OMHSAS); for presenting t h e

awards and posing for photo ops with the award winners!

A great day was had by all due in part by the hard work of the NW3 forum workgroup members: Sherry Billman, Lenore Collupy, Kayleen Hilyer, David Gaines, R. David Giles, Eric Schweter guided by Shelley Thomas, VBH-PA NW3 PE&O Coordinator. Thanks to all for such a successful event!!

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ValueAdded—December 2013 

Source:  h p://www.choosingwisely.org/doctor‐pa ent‐lists/american‐psychiatric‐associa on/ 

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ValueAdded—December 2013 

Winter 2014 WPIC Videoconferences VBH-PA is pleased to announce that our service center will once again be a videoconferencing site for the WPIC Office of Education and Regional Programming videoconference series. These programs are free of charge and there are NO fees for continuing education credits.

The videoconferences are held from 9:00 a.m. to 11:00 a.m. in the Walnut Room at VBH-PA’s Trafford Service Center. You are invited and welcome to attend.* For CEU information, registration information, and complete descriptions of these trainings, please click here.

Upcoming Videoconferences:

New for 2014—DSM-5 Videoconferences!

January 15—Autism Spectrum Disorder and Intellectual Disability in DSM-5 January 29—The Evolution of Psychosis in the DSM-5 February 12—DSM-5: Changes in Substance Abuse February 26—Mood Disorders in DSM-5: What’s New and What’s Not March 12—Feeding and Eating Disorders in DSM-5 March 26—DSM-5: The Diagnosis of Dementia to Meet Real World Needs

and Sleep/Wake Disorders

Registration:

To register for these trainings, please visit the ValueOptions Provider Trainings Web page. Select Pennsylvania from the state dropdown list (DO NOT change any of the other fields) and then click on Select. Scroll down the screen and put a check mark in the box next to the event(s) and then hit Register. Phone-in registrations will not be accepted.

*Please Note: These videoconferences are NOT webinars. You must be in attendance at the Trafford Service Center to view these videoconferences. VBH-PA is one of many sites offering this opportunity. Please click here to view all locations offering this videoconference series. To register with another location, please contact the coordinator for that site.

Suggestions or ideas for articles that you would like to see published in ValueAdded can be faxed to Kim Tzoulis, ValueAdded Editor, at (724) 744-6363 or emailed to kimberly.tzoulis@ valueoptions.com

Articles of general importance to the provider network will be considered for publication. Value Behavioral Health of PA, Inc. 520 Pleasant Valley Rd Trafford, PA 15085 Phone: (877) 615-8503 Fax: (724) 744-6363 www.vbh-pa.com