State of Maryland Department of Health and Mental Hygiene

1
State of Maryland Department of Health and
Mental Hygiene VALUEOPTIONS
Clinical Training for OMS Providers

• September 2009

2
Presenters

• Nancy Calvert, Director, Provider Relations,
  ValueOptions Maryland
• Jennifer Lowther, Clinical Director,
  ValueOptions Maryland

3
Agenda

• Update
• Outcomes Measurement System
• Overview of ProviderConnect
• Requesting Authorizations
• Questions

4
Updates

• ValueOptions Maryland Website
• http//maryland.valueoptions.com
• Provider Alerts
• MHA Policy Clarification Memos and Announcements
• ValueOptions Maryland Updates and Announcements
• Training Schedule
• ProviderConnect tips
• Maryland Specific ProviderConnect demo
• Provider Forms including a hard copy concurrent
  review form
• Coming Soon
• Provider Manual
• Diagnostic Crosswalk
• Fee Schedule
• Service Grid
• Consumer Information

5
OMS Information on Website

• http//maryland.valueoptions.com
• For Providers
• Provider Forms
• OMS Tools
• Discharge Information Sheet
• Adult Questionnaire
• Definitions for Adult OMS Interview
• Adult Questionnaire Response Cards
• Adult Discharge Form Consumer Not Participating
  
• Child and Adolescent Questionnaire
• Child and Adolescent Response Cards
• Child and Adolescent Discharge Form Consumer
  not Participating
• The OMS Interview Guide will be included in the
  Provider Manual

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September 25th System Upgrades

• Online Uninsured Eligibility Registration
  (request function) is now available to providers.
• Axis 1-V diagnoses are now required on concurrent
  reviews
• The Individual Care Plan
• The Plan tab has been added to the Mobile
  Treatment authorization request screen.
• The Service Code Field has been removed
• Providers now have the option to print the Plan
  separately.
• MCO is no longer a required field.
• Education Level has been deleted from the
  federally required questions.
• N/A is no longer an option to the Race
  question.

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Outcome Measurements System(OMS)

• Measures consumer outcomes regarding the
  management of their illness and the quality of
  their lives.
• Supports recovery and resiliency
• An important measure of the benefit provided by
  services in the PMHS

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OMS

• In effect since September 2006
• Collaboration between
• Mental Hygiene Administration (MHA)
• University of Maryland Systems Evaluation Center
  (SEC)
• MHA Administrative Service Organization (ASO)
• Only for outpatient services provided by
• In-state providers
• Hospital outpatient clinics
• Federally Qualified Health Centers (FQHC)
• Outpatient Mental Health Clinics (OMHC)
• Local Health Departments
• Consumers
• Ages 6-17 and 18-64
• Regardless of age, Dually eligible
  Medicare/Medicaid consumers are excluded from OMS

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OMS Questionnaires

• Separate questionnaires for adults and youth
• Adult questionnaire contains the BASIS-24
  questions
• Cover several life domains
• Living situation, Employment, School attendance,
  Substance use, Legal system involvement,
  Symptoms, Functioning, etc
• Administered every six months
• Documentation of completion should be included in
  the consumers clinical contact/progress notes.

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OMS Service Bundle

• 150 Unit Service Bundle Includes
• 2 outpatient evaluations (90801)
• 2 family therapy sessions without consumer
  present (90846)
• Medication management
• Individual Therapy
• Group Therapy
• Excluded
• All extended therapy codes
• Additional sessions of 90801 or 90846
• Services associated with crisis bed stays
• Intensive Outpatient Services (IOP)
• Partial Hospitalization Programs (PHP)
• Initial and subsequent inpatient care
• Combination of service rules apply
• http//maryland.valueoptions.com/provider/announce
  ments/2005_Announcement_Archive.pdf

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Services Included in the OMS Authorization

• 90801 Initial Evaluation
• 90804 Individual Psychotherapy (20-30 minutes)
• 90805 Individual Psychotherapy with Med
  Eval/Mgmt
• 90806 Individual Psychotherapy (40-50 minutes)
• 90807 Individual Psychotherapy with Med
  Eval/Mgmt
• 90846 Family Psychotherapy without Patient
  Present
• 90847 Family Psychotherapy with Patient Present
• 90849 Multiple Family Group
• 90853 Group Therapy
• 90862 Medication Management
• 90875 Individual Psychotherapy with Biofeedback
• 90876 Individual Psychotherapy with Biofeedback
• T1015 FQHC Clinic Visit
• Rev Codes 0510, 0513, 0910, 0914, 0915, 0916,
  0917, 0918, 0919

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OMS Services, continued

• Discharge Codes (included in the authorization
  bundle)
• 90889
• 0929
• Not included
• Extended visit codes (90808, 90809)
• More than two initial evaluations (90801)
• More than two family psychotherapy without
  patient present services (90846)
• Separate pre-authorization required

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OMS Registration/Authorization

• Initial Registration
• 2 visits/3 months
• 2 additional visits may be requested
  telephonically under special circumstances
• Continuing Registration (150 bundle)
• May be requested with the initial registration
• The start date of the continuing registration
  will always the day after the date of the OMS
  interview
• End of Authorization/Discharge
• May be performed up to 10 days after the
  authorization is closed
• After 100 days neither a continuing OMS nor a
  discharge OMS will be accepted.
• With consumer present
• Discharge Information Sheet
• OMS Questionnaire
• Without Consumer Present
• Discharge Information Sheet
• Discharge OMS Form

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End Users License Agreement(EULA)

• Required for all OMS Providers of service to
  adults
• OMHC, FQHC, Hospital Based Clinics
• Allows inclusion of the BASIS-24 questions
• Return a signed copy to ValueOptions Maryland
• Maintain individually signed copies in staff
  personnel files
• Failure to sign
• Questionnaire must still be completed (minus the
  BASIS 24 questions)
• Providers will only receive 12 visits per
  authorization period.
• Available on both the MHA and ValueOptions
  Websites
• Contact Teana Jones
• 410-691- 4015 Fax [phone]
• Scotteana.jones_at_valueoptions.com

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ProviderConnect
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ValueOptions ProviderConnect
ProviderConnect is an online tool that increases
convenience decreases administrative burden.

• Free, secure, online application
• Easy access 24 hours a day, 7 days a week
• Complete multiple transactions in a single sitting

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ValueOptions ProviderConnect Features
With ProviderConnect providers can

• Verify Consumer eligibility
• Register Uninsured Consumers
• Request Authorizations
• View Authorizations
• Submit Claims (Batch and Direct/On-line claim)
• View Claim Status
• View and Print Provider Summary Voucher
• Submit inquiries to Customer Service
• Access and print forms

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Accessing ProviderConnect

• Each provider has a secure login and online
  registration, including a provider ID number via
  the ProviderConnect Web site.
• Additional logins for other providers in the same
  practice are available through ProviderConnect.
  Contact

ValueOptions EDI Helpdesk [phone],
Option 3 Monday through Friday 8 a.m. 6 p.m.
EST
Turn around time for additional logins is 48
hours.
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OMS Authorization Requests

• Live Demonstration

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Questions
valueoptionstransition_at_dhmh.state.md.us
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Please complete the survey that will appear
shortly.

• THANK YOU!