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Value Options?

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Christy:
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:
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. 

Christy:
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:
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.

PMRNC:


--- 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
--- End quote ---


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.

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