ValueAdded

This is the 210th issue of our VBH-PA information update. These updates will be

emailed to network providers monthly. Please feel free to share our newsletter

with others, and be sure your appropriate clinical and financial staffs receive

copies.

Inside this issue

Psychological/Neurological Testing Request Form ............. 2 Updated Request for RTF Hold Bed Days Form ............... 3 Seeking CRR/Host Home Services for Children ............... 3 Fraud and Abuse Training for New Providers ................... 3 County Notification of High Priority Reportable Incidents .. 4 Reporting of Critical Incidents: Updated Training and Forms .. 5 Claims Corner: Autism Coverage ..................... 5 Save the Date! 17th Annual Adult Recovery Forum ............ 6

Vol. 18 Issue 12 December 2016

Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA)

by calling their Provider Field Coordinator or through notification in writing by mail,

email or facsimile to 1-855-541-5211 (attention Provider Relations Department)

upon the occurrence of any of the following:

1. Inability to provide emergent care within one hour, urgent care within 24

hours, or routine care within seven days.

2. Usage of alternative provider coverage in any situation when unable to treat

VBH-PA members in active treatment, e.g. vacation.

3. When reaching full (100%) capacity. Full capacity is considered the point at

which the provider is unable to meet the access standards noted above or is

unable to accept referrals for a particular level of care. Notices for full

(100%) capacity should contain the reason for reaching capacity, the

effective date, and the steps the provider will take to resume functioning at

normal capacity.

4. The inability to provide any portion of a prescribed service, e.g. BHRS.

Network providers must offer hours of operation that are no less than the hours of

operation offered to commercial members or comparable to Medicaid fee-for-service

if the provider serves only Medicaid members. You may find this information in our

online Provider Manual:

http://www.vbh-pa.com/provider/info/prvmanual/4_PartPrvResp/

notification_change_access_svcs.htm

Notification of Change in Access

to Services

2 ValueAdded—December 2016

Psychological/Neurological Testing Request Form

Have you ever had a Psychological/Neurological Testing Request Form returned to you

because it was incomplete or because incorrect information was provided? While it is

very important to complete this form in its entirety, here are the most common reasons

your form may have been returned:

Patient Information: Be sure that all four fields are complete and accurate. If we cannot find a member based on the information provided, we simply cannot process your request.

Psychologist Information: All fields must be completed in order for us to be sure we are creating an authorization for the correct psychologist or provider. If you do not know your six-digit Provider ID number, please contact your Provider Field Coordinator or call 1-877-615-8503.

Diagnosis:

Primary and Additional Behavioral Diagnosis: The ICD-10 code as well as the description must be included (abbreviations for the description are acceptable). If one or both are not included, or if they do not correlate, the form will be returned.

Social Elements Impacting Diagnosis (include all that may apply):

Educational problems

Occupational problems

Financial problems

Other psychosocial environmental problems (please specify)

Problems with access to health care services

Problems related to interaction with legal system or crime

Problems with primary support group

Housing problems (not homelessness)

Homelessness

Medical disabilities that impact diagnosis or must be accommodated for in treatment

Problems related to the social environment

Unknown

None

Optional Functional Assessment: Include the name of the assessment along with the score if an assessment was completed.

Testing Requested: Always include the specific test planned, the number of hours required for that specific test, as well as the total hours required for all requested testing. Please note that the time required for each test should include administration, scoring, interpretation, and write-up.

Signature: Always sign and date.

REMINDER: Upon receipt of a request for authorization for services, by phone, electronic submission, or fax transmittal,

VBH-PA has 10 business days to enter a provider's authorization. Providers should be able to access authorizations within

two business days of a decision. An icon will appear on the ProviderConnect homepage indicating that new authorization

letters are available. Click on the link on the ProviderConnect homepage to go to links to new authorization letters. Print the

letters or save them to your computer. Only approval letters are electronic. Adverse determination letters will continue to be

sent to providers via U.S. Mail. If you cannot access an authorization and it has been more than 10 business days since you

submitted the request, please do not hesitate to call us at 1-877-615-8503. Please do not resubmit your request until you have

contacted us.

Here is the link to the Psychological/Neurological Testing Request Form: http://vbh-pa.com/provider/info/clinical_ut/

PER-Form.pdf.

3 ValueAdded—December 2016

Seeking Community Residential

Rehabilitation (CRR)/Host Home

Services for Children Value Behavioral Health of Pennsylvania (VBH-PA) maintains a comprehensive network of

providers providing services to individual HealthChoices recipients in need of mental health

treatment. This extensive network provides a diversity of location, choice and specialization

for all HealthChoices members.

Despite this comprehensive network, VBH-PA has identified a need for additional

Community Residential Rehabilitation (CRR) services for our underserved Fayette County

residents. In addition, other counties may be open for CRR/Host Home services. You can

view them on our website at http://www.vbh-pa.com/provider/prv_open_netwk_svcs.htm.

CRR services are provided in Host Homes which are family dwellings that provide 24-hour

living arrangements and mental health treatment for children and adolescents with psychiatric

and/or behavioral health needs that would benefit from treatment in a natural home-like

environment within the community.

CRR services may be an appropriate treatment option for children and adolescents under the

age of 21 requiring out-of-home treatment; older adolescents with mental health needs who

are preparing to live independently; children whose mental health symptoms are expected

to improve in a family environment rather than a group treatment environment; children/

adolescents in need of a step-down level of care from an RTF; or children/adolescents in

need of a level of care offering increased intensity of treatment when community and home-

based interventions are not sufficient.

CRR services are child treatment programs licensed under Chapters 5310, 3860 and 3130 of

the Pennsylvania Code and certified by the Office of Mental Health and Substance Abuse

Services (OMHSAS) and the Office of Children, Youth and Families (OCYF). Because CRR

services are dually licensed residential levels of care, providers must ensure that their host

families meet both OMHSAS and OCYF standards and requirements.

If you are currently a CRR provider looking to expand, or if you are a provider that is

interested in providing CRR services, please contact Andrea Poole, Provider Field

Coordinator, at (724) 430-1377 or email her at andrea.poole@beaconhealthoptions.com.

Updated! Request for RTF Hold

Bed Days Form

This form has been

updated to include two

fax numbers

dependent upon the

county for submission.

The form is located on

our Provider Forms

webpage at http://

www.vbh-pa.com/

provider/prv_forms.htm,

listed under Clinical/

Utilization Management

Forms.

Fraud and Abuse Training

for New Providers Thursday, December 29, 2016

1:00 p.m. to 2:30 p.m. This webinar is for new providers to the VBH-PA network and meets the

mandatory training requirements for fraud and abuse.

Register Now:

https://attendee.gotowebinar.com/register/6376298099564417026

4 ValueAdded—December 2016

View all of our

upcoming trainings on

the Provider Trainings

webpage: http://

www.vbh-pa.com/

provider/prv_trn.htm

Upcoming BHRS Summits

(Your choice of two

locations per month.)

CANCELLED

December 2 —

Courtyard by

Marriott

Greensburg, PA

December 9 —

Hampton Inn &

Suites

Mercer, PA

County Notification of High Priority

Reportable Incidents

The safety of our members is one of the key areas of focus of the VBH-PA Quality

Management (QM) Department. Our staff are trained and experienced to assess, triage,

and investigate reportable incidents that are brought to our attention from across our 13-

county service area. Effective October 15, 2016, a new step was added to our process to

ensure that all counties are made aware of select high priority reportable (critical) incidents.

The VBH-PA QM Department will be responsible to notify participating county liaisons

when critical incidents are reported that meet the following criteria:

Incident Category

Suicide/Completed Death

Physical Assault (resulting in death and/or requiring emergent care)

Completed/Attempted Homicide (beyond a verbal threat)

Alleged Sexual Assault/Non-Consensual Sex

Media Event (resulting in disruption of member care/service, impact on member safety and/or

potential member endangerment)

The QM Department will maintain a listing of county liaisons. In the event that one of these

categories of critical incidents is reported, an informational email notification will be

forwarded to all county liaisons making them aware of the reported incident. This

communication will note the initiation of the investigation and notice that if substantiated it

will be referred to the Quality of Care Committee (QOCC) within a timeframe sensitive to

the level of severity of the reportable incident issue.

If the investigation is substantiated, the QM Department will send a follow-up notification

to the county liaisons along with a member listing provided by the VBH-PA Data Analytics

team for potential action, as deemed appropriate and recommended by the members of the

QOCC.

This process will only include settings involving any VBH-PA contracted provider facility/

office location currently participating/credentialed in our network.

As a network participating provider you are encouraged to continue to forward to VBH-PA

all reportable incidents that come to your attention. Please submit these on the VBH-PA

Critical Incident Log which can be found on the Provider Forms webpage under “Quality

Management Forms.”

Thank you for being a valued provider.

5 ValueAdded—December 2016

Reporting of Critical Incidents – Updated Training

and Forms

Value Behavioral Health of Pennsylvania is committed to assisting providers with

risk reduction as part of our ongoing quality improvement program. While

adverse incidents are reviewed individually, less severe incidents are reviewed in

aggregate form in order to identify trends within particular provider programs, by

levels of care, age, or other demographic data across the full provider network.

All providers are required by contract to report critical incidents directly to the

VBH-PA Quality Department regardless of other reporting requirements. A best

practice would be for providers to address this requirement by internal policy and

include a list of all entities/contacts that receive the incident reports. This would help ensure that during times of staff

change, illness, or other time off, reporting will continue uninterrupted.

The Table of Incidents which are required to be reported and the updated 2016 Critical Incident Reporting Log are

available on the VBH-PA website under Provider Forms – Quality Management. Reports may be faxed to 1-855-287-

8491, or emailed to criticalincident@beaconhealthoptions.com.

A webinar training with VBH-PA providers will be conducted on December 8, 2016. The training materials are located on

our website on the Provider Trainings webpage, under Quality Management. A recording of the webinar will also be

uploaded to the website soon.

Autism benefit verification is required from those providers delivering services to children up to age 21 who have an

autism diagnosis (ICD-10 F84.0 – F84.9) and have a private insurance coverage. To ensure that VBH-PA has the most

accurate information, VBH-PA will only accept the following documentation:

Explanation of Benefits (EOB) for all services being delivered

Determination of coverage letter with approvals/denials due to

a. Exclusions

b. Medical Necessity Criteria

c. No coverage for autism services

Letter from the employer stating there are less than 50 employees and/or the insurance plan does not cover services

for the autism diagnosis

The information requested on the ACT 62 Fax Cover Sheet is still required and should accompany the documentation

listed above. NAVINET PRINT-OUTS WILL NOT BE ACCEPTED. The ACT 62 Fax Cover Sheets are listed on

the Provider Forms webpage, under Clinical/Utilization Management, BHRS Forms: http://www.vbh-pa.com/provider/

prv_forms.htm. Please allow 10 business days from receipt to process coverage verification information.

Autism Coverage—Acceptable Benefit Verification Information

6 ValueAdded—December 2016

Welcome!

Katie Zirkel started on

November 21st as a

part-time

Administrative

Assistance in the Peer

Office.

Please join us in

welcoming Katie to

VBH-PA!

Suggestions or ideas

for articles that you

would like to see pub-

lished in ValueAdded

can be faxed to Kim

Tzoulis, ValueAdded

Editor, at (724) 744-

6363 or emailed to

kimberly.tzoulis@

beaconhealthop-

tions.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

Save the Date Value Behavioral Health

of Pennsylvania Presents the

17th Annual

Adult Recovery Forum

Friday, April 21, 2017

Pittsburgh Marriott North

Cranberry Township

Please start thinking about outstanding individuals whom you

would like to nominate in your County. Visit www.vbh-pa.com

in January for information on the upcoming forum and to

download the nomination form. Deadline for nominations

will be March 1, 2017.