Author Topic: Value Options?  (Read 3393 times)

Christy

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Value Options?
« on: March 12, 2014, 12:33:37 PM »
Hi all,

I am signing up a LCSW R who is a participating provider with Value Options. She told me that she takes MVP (NY)- Value Options only. But, if a provider is enrolled with Value Options, wouldn't she be par with any carrier that uses Value Options for mental health?  For example the Empire Plan in NY now uses Value Options for mental health. Even though the provider does not have participation with Empire Plan directly, wouldn't she be par via Value Options?

Also, do claims go directly to Value Options? Do they usually require an authorization?

thanks!

Michele

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Re: Value Options?
« Reply #1 on: March 12, 2014, 01:24:09 PM »
Mental Health services through Value Options do require an auth, at least all of the plans that we bill do!  Yes, the claims go directly to VO. 

As for the first part of your question, I always thought that if a provider was in network with VO that they took any VO plan.  I'm not sure why they would only take MVP.  It may be that she doesn't understand participation?  Maybe she signed up specifically for MVP and doesn't realize she can take any VO patient. 
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Christy

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Re: Value Options?
« Reply #2 on: March 12, 2014, 01:52:55 PM »
thanks Michele!

Yes, I think the provider is mistaken in thinking that she only takes MVP.

Does Value Options require an auth for the 1st visit?

One more Q: can an LCSW (without the R) be participating in VO?

thanks so much!!!!

rdmoore2003

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Re: Value Options?
« Reply #3 on: March 12, 2014, 02:02:09 PM »
If you use ValueOptions website for benefits, be careful!  They do not always have correct information, no matter what group it is.   I have found with them, that they may not "require" an authorization for the initial visit, however, it is best to get it anyway.   Out of all the insurances I deal with for mental health, I do not care for some of their guidelines.
Regina

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Re: Value Options?
« Reply #4 on: March 12, 2014, 02:11:14 PM »

Quote
As for the first part of your question, I always thought that if a provider was in network with VO that they took any VO plan


Nope, this is not to be said about any insurance company contract. This is what the state of NY is seeing a lot of right now because of the ACA... YOUR provider contracts play the KEY role in whether you are par or not.  You have to look at the actual contract.. be prepared because many MH providers have no idea where the contract is much less have they read them before they signed them.   Value options is one of those TPA's that DO indeed contain all payor clauses unless you rejected it and/or negotiated it out. If you have several Value options plan and your PM software has capability of running a "par fee report" (also depends on how you loaded your adjustments and or identifiers for the carrier) you will find some of their plans VARY a LOT on reimbursement. That is why for my MH clients I review their contracts and we get that clause negotiated out for certain plans.
Linda Walker
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PMRNC

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Re: Value Options?
« Reply #5 on: March 12, 2014, 02:13:16 PM »
To clarify, many NY providers are saying they are NON par with "OBAMACARE" when in all actuality they have an all payors clause in the contracts they signed with the insurance companies offering up exchange plans in NY. They are seeing this very problem in other states too.   
Linda Walker
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Christy

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Re: Value Options?
« Reply #6 on: March 12, 2014, 03:12:50 PM »
thanks ladies!!

Linda, so you are saying that even though the claims go through VO, the pay rate is dependent on the actual carrier?

Since I am relatively new to mental health, I am wondering with VO- who does the actual payment come from, VO or the carrier?


PMRNC

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Re: Value Options?
« Reply #7 on: March 13, 2014, 11:43:10 AM »
Value Options is one of the largest MH TPA's in the country, they are a Third Party Admin with clients such as GHI, many unions, and really big companies. They actually have a page that outlines ALL of their networks. http://www.valueoptions.com/providers/Network.htm

An example is that Value Options took over administration of the Empire Plan (NY) we were PAR with the Value Options Network but we still had to complete another enrollment in addition to webinar that providers had to take for credentialing in this plan. The ones who didn't could still maintain VO status but authorizations and in some areas fee-schedules were reduced. Confusing but like I said if you take the time to review ALL of the provider contracts your client has you will be the better for it.
Linda Walker
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Christy

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Re: Value Options?
« Reply #8 on: March 13, 2014, 12:57:26 PM »
thanks, Linda. You are always a big help! :)

Christy

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Re: Value Options?
« Reply #9 on: April 01, 2014, 10:06:41 AM »
I have another Value Options question?

I see that VO assigns their own id # to each patient, which is different than the patient's actual id# with their individual carrier. Can we submit claims with the carrier id# or only the VO id#?

How do you obtain the VO id#?

I have never seen this with any other TPA?

help!

thanks!

rdmoore2003

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Re: Value Options?
« Reply #10 on: April 02, 2014, 10:34:04 AM »
Have you signed up for their website?  Once you log onto VO website, you can search for member with their ID# and the page will display the VO ID and other information.  Remember that VO benefits page is not always correct.  I have spoken with them time and time again.  I have been told that they prefer to have you call in for the verification.   VO is prompt about getting us our payments quickly, and I mean within 7 business days (EFT).   However, when precerting for psychological testing, their guidelines are a bit strange.   An MMPI is approx. 600 questions.  VO thinks that a patient should be able to answer all these questions, doctor to score & interpret, and report write up time all in 1 hour.
Regina

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Re: Value Options?
« Reply #11 on: April 02, 2014, 01:36:34 PM »
They are one of my favorite MH TPA's..
I've noticed they do things a bit different for their EAP patients.. they do NOT use the Value Options ID number from patient's ID card because EAP is a very strict and confidential benefit which is in NO way tied to their major med benefits. We have some patients with two ID numbers because one is EAP and the other is their Major Med ID.

I too think they are one of the fastest payers. I also verify benefits with them on the phone and it's MUCH quicker than their website.
Linda Walker
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Christy

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Re: Value Options?
« Reply #12 on: April 04, 2014, 01:25:03 PM »
thanks so much, Linda and Regina!