ValueAdded This is the 210 th 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 Tesng 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 Noficaon of High Priority Reportable Incidents .. 4 Reporng of Crical Incidents: Updated Training and Forms .. 5 Claims Corner: Ausm 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
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Vol. 18 Issue 12 December 2016 ValueAdded · December 2016 Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA) by calling their Provider Field Coordinator
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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
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