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ValueAdded
This is the 195th 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
PROMISe™ Numbers and Service Locations ................................. 2
Rebranding of ProviderConnect Guides ..................................... 2
Third Party Liability.................. 3
Coordination of Benefits ........ 3
ICD-10 Transition .................... 4
National Recovery Month ...... 5
9th Annual Family Forum ....... 6
Happy Retirement! ................. 6
8th Annual NW3 Family & Adult Behavioral Health Forum ........ 7
Seeking Nominations for the 8th
Annual NW3 Family & Adult Behavioral Health Forum ........ 8
WPIC 2015 Fall Videoconference Series ...................................... 9
Vol. 17 Issue 9 September 2015
Child Abuse History Certification
Applications
Individuals applying for their Child Abuse History Certification* can apply, and if
applicable, pay online at www.compass.state.pa.us/cwis. The Department of
Human Services (DHS) strongly encourages applicants to apply for their Child
Abuse History Certification electronically, as this streamlines the process and makes
it more efficient for the applicants. For applicants who prefer to apply for their
Child Abuse History Certification by paper, DHS will continue to accept paper
applications. Please know that submitting a paper application takes additional time
to process.
For individuals applying for their Child Abuse History Certification for non-
volunteer purposes, the fee has been reduced to $8. DHS will be issuing refunds
for overpayment of fees for those applications that were submitted after July 25,
2015. For applications submitted with an overpayment prior to July 25, 2015, no
refund will be issued.
For individuals applying for their Child Abuse History Certification for volunteer
purposes, the fee has been waived and no payment is required. For those
applicants submitting payment with an application for volunteer purposes, the
application will be processed and the payment will be returned.
*By law, the term “clearance” has been changed to “certification” for volunteer and non-
volunteer purposes.
Source: The Department of Human Services, Office of Children, Youth and Families
2
ValueAdded—September 2015
PROMISe™ Numbers and Service
Locations Employees on the Move
Diane Werksman,
MBA accepted the
position of Interim
CFO for VBH-PA. She
has been with VBH-
PA from the
beginning, and we
look forward to her
leadership and
direction going
forward.
Congratulations
Diane!
The Road Ahead—
Rebranding ProviderConnect Guides
As we continue with our branding updates, you may have noticed that our
Getting Started with ProviderConnect Guide was recently converted to the
Beacon Health Options’ brand. In addition, the ProviderConnect User Guide
was rebranded and modified to reflect updates from June 2015 system
enhancements. Please be advised that the ProviderConnect platforms you
use will continue to say ValueOptions as we are a Beacon Health Options’
company.
To access these guides, as well as other useful information to assist with
utilizing our electronic resources as part of your daily practice, we encourage
you to visit our website’s ProviderConnect Helpful Resources page.
Providers must have a current and
active PROMISe™ number in order to
submit claims to VBH-PA. Of equal
importance, every service location must be
enrolled in PROMISe before billing for
any services out of that site. If you move
or change the nature of a service, you must
enroll in PROMISe before claims can be
submitted. Each service location is
assigned a service location number which
is the four-digit number at the end of your
PROMISe number.
You cannot use the PROMISe
service location number assigned for a
service at one service location if you
move the service to a different service
location. If you move into a new office
and provide services out of that office, you
will not be able to bill for any services
from that location until you receive your
new PROMISe service location
number. And you cannot bill for any
services that occurred prior to the
PROMISe number effective date. In order
to continue to use your current PROMISe
service location number and be reimbursed
for services, you will have to maintain your
current office location until you receive a
PROMISe service location number specific to
a different location. The only exceptions are
regarding mental health satellite offices.
For MH OPT Clinics and MH Partial
Programs: Satellite offices DO NOT need
to enroll in PROMISe because the satellite
offices will be listed on the Certificate of
Compliance under the main location with
the same facility number. Providers will
use the main location’s 13-digit PROMISe
number.
For DA OPT Clinics and DA Partial
Programs: Satellite offices DO need to be
enrolled in PROMISe because the satellite
offices will be listed separately on their
Certificate of Licensure, and you will see
different facility numbers listed on the
license as well. Each site will need its own
location number as noted above.
If you have any question regarding
PROMISe numbers, you can access the link
below and/or call the PROMISe hotline also
contained in the link. You may also contact
your VBH-PA Provider Field Coordinator at
1-877-615-8503 should you have any
questions.
http://www.dhs.state.pa.us/provider/
promise/enrollmentinformation/S_001994
3
ValueAdded—September 2015
Upcoming BHRS & RTF Summits
BHRS SUMMITS
(Your choice of two
locations per month.)
September 9—
Courtyard by Marriott
Greensburg, PA
September 11 —
Hampton Inn & Suites
Mercer, PA
December 4—
Courtyard by Marriott
Greensburg, PA
December 11 —
Hampton Inn & Suites
Mercer, PA
RTF SUMMITS
October 9 —
Doubletree by Hilton,
Mars, PA
.
Third Party Liability
VBH-PA is the payor of last resort. The Third Party Liability (TPL) information contained
within ProviderConnect should be reviewed at the time services are delivered. Providers
must follow the primary insurance carrier’s procedures regarding authorization/certification,
timely filing, and claims submission. If you do not provide an Explanation of Benefits from
the primary carrier with your secondary claim, the claim will be denied by VBH-PA.
Listed below is helpful information to reference when providing and billing services to VBH-
PA that require an explanation of benefits from the primary insurance carrier.
Providers must always confirm the following information with the member prior to service
delivery:
Does the member have private insurance?
If yes, obtain a copy of the front and back of the private insurance card.
Determine if there is a carve-out responsible for managing behavioral health
benefits.
Contact private insurance plan (carve-out) to obtain authorization (if required).
Submit claims to the private insurance plan within their timely filing guidelines.
Coordination of Benefits
All primary insurances must be billed prior to submitting the claim to VBH-PA.
Providers and members must follow the primary carrier’s requirements.
Providers who are not in-network/non-participating with the primary carrier’s
network should request an out-of-network arrangement with the primary carrier or
redirect the member to the primary carrier for referrals to an in-network or
participating provider.
VBH-PA considers the Patient Responsibility/Member Liability/Patient Liability
(coinsurance/co-pays/deductibles) on the Explanation of Benefits and will only pay
up to the VBH-PA contracted rate in most cases.
Inappropriate Primary Carrier Denials
Primary Carrier requirements were not followed
Primary Carrier denial for no authorization
Primary Carrier denial for not meeting timely filing requirements
Primary Carrier denial for rendering provider not being contracted/
credentialed
Please contact the VBH-PA Customer Service Department at 1-877-615-8503 if you have
any questions. Customer Service is available for assistance Monday through Friday from
8: 00 a.m. – 5:00 p.m.
4
ValueAdded—September 2015
ICD-10 Transition—Are You Ready?
In compliance with current federal mandates, ValueOptions® and Value Behavioral Health of Pennsylvania, Inc. will be transitioning to the ICD-10 coding system on October 1, 2015.
Requirement The U.S. Department of Health and Human Services has issued a rule finalizing October 1, 2015 as the compliance date for all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to transition to using the new ICD-10 code sets. HIPAA-covered entities include:
Providers
Payers
Clearing Houses
Billing Services
Rationale ICD-10 coding system will replace the current ICD-9 coding system. This transition is expected to allow physicians and other healthcare providers to document clinical care more precisely and has the potential to ensure more accuracy around reporting and evaluating medical necessity for services provided. Following are links to resources our provider network will find useful while preparing for the transition.
ValueOptions® ValueOptions ICD-10 Resource Portal
CMS Guidance: ICD-10 The Centers for Medicare & Medicaid Services (CMS) has release numerous written and video communications regarding ICD-10. Other information can be found on the CMS.gov website, also listed below. ICD-10 Introduction Fact Sheet CMS ICD-10 Website Sign Up for CMS ICD-10 Industry Email Updates
ICD-10 Training Resources Prepare for compliance with the ICD-10 mandate via ICD-10 general and implementation training. A sampling of industry resources are listed below. American Health Information Management Association (AHIMA) American Academy of Professional Coders (AAPC) ICD-10 Coders Academy This information is intended for general informational purposes. It should not be construed as an endorsement of any organization or product.
5
ValueAdded—September 2015
September is National Recovery Month
SAMHSA’s National Recovery Month is a national observance held every September to educate
Americans that substance use treatment and mental health services can enable those with a
mental and/or substance use disorder live healthy and rewarding lives. The observance
reinforces the positive message that behavioral health is essential to overall health, prevention
works, treatment is effective, and people can and do recover. For more information and
materials, visit: http://www.recoverymonth.gov
Join the Voices for Recovery by visiting a local recovery event!
6
ValueAdded—September 2015
Join Us!
9th Annual Family Forum
For Families with Children in HealthChoices
“Broadening Our Possibilities—Hope for
Tomorrow”
Where: Ramada Greensburg Hotel
and Conference Center
Greensburg, PA 15601
When: Friday, October 2, 2015
Time: 9:15 a.m. to 3:00 p.m.
Featuring:
Kelly Frey, WTAE Morning News Anchor
Bethany Yeiser, Daughter and Author of Mind Estranged
Karen Yeiser, Mother and Author of Flight from Reason
Tons of exhibitor tables
The ever-inspiring Exceptional Parent/Caregiver Award Ceremony
EXHIBITORS Would you like to exhibit at this year’s forum?
Visit our homepage at www.vbh-pa.com for the Family Forum
Exhibitor Registration Form.
GENERAL REGISTRATION Would you like to attend this year’s forum?
Visit our homepage at www.vbh-pa.com for the Family Forum Registration Brochure.
HealthChoices’ families living in Armstrong, Beaver, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Washington and Westmoreland Counties
are invited to attend. Mercer, Crawford and Venango Counties HealthChoices’ families will have the opportunity to attend other regionally held
VBH-PA forums in 2015.
Shar Whitmire, Director of Provider Relations for Value Behavioral Health of
Pennsylvania during the past 17 years, officially retired August 28th. Her hard
work, dedication and leadership will be greatly missed. With retirement comes
new horizons, and we here at VBH-PA hope that Shar enjoys every second of
her new found freedom. If she puts as much effort into enjoying her retirement
as she has all the years she’s been working at VBH-PA, her retirement will be truly
amazing! Please join us in wishing her well.
7
ValueAdded—September 2015
Save the Date for the Crawford, Mercer & Venango counties’
behavioral health forum! Featuring the “Exceptional Individual and
Parent Awards” and Clarence Jordan, Beacon Health Options’ VP of
Wellness and Recovery. Education and information presented to
enhance and empower participants’ recovery journeys.
Free for all attendees.
“Acknowledging the Journey”
Thursday, November 12, 2015
9:00 a.m. to 4:30 p.m. (Registration begins at 8:00 a.m.)
Park Inn by Radisson, 3377 New Castle Road (Rt 18)
West Middlesex, PA 16159
Registration brochure coming soon! However, we are now accepting
exhibitor reservations (see below) and nominations for the Exceptional
Individual Awards (see next page).
Attention Prospective Exhibitors!
Reservations are open to exhibit at the 8th Annual “Acknowledging the Journey,” a
behavioral health member forum for HealthChoices members residing in Crawford, Mercer
and Venango counties. The NW3 Forum Exhibitor Registration Form is currently available on
the VBH-PA homepage, under the Provider and Member News and Events sections at
www.vbh-pa.com.
If you have any questions, please contact Shelley Thomas, PE&O Coordinator, at (724) 962-
8032 or 1 (866) 404-4561, or by email at [email protected].
“Acknowledging the Journey” 8th Annual Family & Adult Behavioral Health Forum
A Value Behavioral Health of Pennsylvania Family And Adult Members Forum
Crawford, Mercer and Venango Counties
Exhibitors at work engaging with consumers and educating them with resources. Pictures from 2014 Forum.
8
ValueAdded—September 2015
Would you like your efforts and supports acknowledged through the
progress and empowerment of a VBH-PA member whom you have
served?
Are you inspired by hearing people’s stories of recovery and
resiliency?
Nominate someone you consider as an Exceptional Individual, Parent or Caregiver!
** Nominations are now open and need to be submitted by Friday, October 16, 2015. **
Once again, this year’s event program will acknowledge all nominations and award winners’ names
along with each agency who takes the time and effort to nominate a deserving individual. Many of you
have already experienced the inspiration of seeing people being “Acknowledged for their Journey” and
being recognized as an Exceptional Individual or Family Member. VBH-PA thanks you for the part you
play in this effort.
Please consider nominating a VBH-PA HealthChoices member whom you consider exceptional reflected
by their active journey and their engagement of and encouragement to other members in theirs. Please
nominate at least one HealthChoices VBH-PA member residing in one for the northwest three (NW3)
counties of Crawford, Mercer or Venango. Two awards will be given for each county. One award will be
given to an adult VBH-PA member for the Exceptional Individual Award. The other award will be given
to a parent or caregiver of a child or adolescent VBH-PA member. A total of six awards will be presented
for all three counties. The individuals nominated will also be acknowledged at this event.
The NW3 Members Forum will publically acknowledge HealthChoices members who have demonstrated
courage, creativity and leadership in their journeys at the:
“Acknowledging the Journey”
8th Annual Behavioral Health Forum
Thursday, November 12, 2015
Park Inn by Radisson, West Middlesex, PA
9:00 a.m. – 4:30 p.m.
(Registration begins at 8:00 a.m.)
The NW3 Forum Nomination Form is currently available on the VBH-PA homepage, under the Provider
and Member News and Events sections at www.vbh-pa.com. Please feel free to re-nominate someone
whom you may have nominated in previous years but did not receive the Exceptional Award.
Please take the time to pass this request onto your many staff members who also do exceptional work
with VBH-PA HealthChoices members. Your agency may nominate as many adult and family members
as they like. The NW3 Members Forum Workgroup will review all nominations and vote. The greater the
detail you include the more likely your nominee will receive the award. Nominations are due by Friday,
October 16, 2015. Thank you for all your hard work in seeing people succeed!
Attention Providers and County Staff!
NW3 2015 Exceptional Individual/Parent Crawford Mercer &
Venango Counties Nominations Needed!
9
ValueAdded—September 2015
2015 WPIC Videoconferences Fall Series!
VBH-PA is pleased to announce that our Engagement Center will be a videoconferencing
site for the WPIC Office of Education and Regional Programming 2015 fall
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 Engagement Center. For CEU information,
registration information and complete descriptions of these trainings, please view
“Upcoming Trainings” on our Provider Training webpage.
Upcoming Videoconferences*
September 16—Evidence Based Treatments for Post-Traumatic Stress Disorder: An Overview
October 14—ECT in Late Life Depression
November 18—Strategies for Working with Reactive Attachment Disorder (RAD) Children in
Adoptive, Residential and Family of Origin Homes
December 9—Mental Health and Homelessness
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 Engagement 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, Val-
ueAdded Editor, at (724)
744-6363 or emailed to
kimberly.tzoulis@
valueoptions.com
Articles of general im-
portance to the provid-
er network will be con-
sidered 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
Contacting VBH-PA
Provider Relations has
never been easier! Click
on the Webmaster email
address below to send an
email:
vbhpawebmaster@value
options.com
