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ValueOptions®: Leading Public Sector Behavioral Health Services in Maryland

ValueOptions® is recognized as a public sector leader, managing the most behavioral health contracts in the industry. Covering over 4.5 million lives across 13 states, it serves Medicaid and uninsured individuals in Maryland’s Public Mental Health System. The two-year contract, approved by the Board of Public Works in June 2009, includes provisions for minority business participation and aims to enhance mental health services for approximately 99,000 individuals. The implementation features extensive staff training and a focus on claims processing efficiencies.

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ValueOptions®: Leading Public Sector Behavioral Health Services in Maryland

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  1. ValueOptions® December 15, 2009

  2. ValueOptions® - Recognized Public Sector Leader • Currently manages more public sector behavioral health contracts than any other company. • More than 4.5 million covered lives across 13 states. • Many of these contracts have Member populations exceeding 400,000, and several exceed 1 million covered lives.

  3. Overview of the ValueOptions® Contract • Approved by the Board of Public Works on June 3, 2009. • Two year contract with 3 one-year renewal options. • Includes a16.6% participation by minority businesses. • Responsible for managing inpatient and outpatient mental health services for Maryland’s Public Mental Health System (PMHS) for approximately 99,000 Medicaid and Uninsured individuals. • Responsible for facilitating the recoupment of all available Federal Fund Participation (FFP). • Began on September 1, 2009.

  4. Customer Service:How are we doing ?

  5. Claims Processing:How are we doing ?

  6. Claims Payments:How are we doing ? • Paper Claims - $41,707,228.83 • Electronic Funds Transfers (EFT) - $96,039,171.77 • Adjustments - ($243,828.60) • Total Claims Payments* - $137,502,572.00 * as of 12/1/09

  7. Claims Payments:Contract with ACS ValueOptions® contracted with ACS, the prior claims processing vendor, to pay claims for dates of service before September, 2009.

  8. Staffing Update • Over 60 ValueOptions® staff, managers, directors and National Leadership participated in the start-up planning and implementation. • Over 20 additional National staff have assisted with the daily operations during implementation. • ValueOptions® currently has 84.75 of its 87.50 budgeted FTE’s hired.

  9. Provider Trainings ValueOptions® Maryland offered over 30 Provider Connect Trainings via Webinars as well as face-to-face trainings in several regions statewide. Topics included: Inpatient/Higher Levels of Care Residential Treatment Centers Outcomes Management System (OMS) Standard Outpatient Psychiatric Rehab Program (PRP) & Residential Rehab Program (RRP) Case Management

  10. Core Service Agency Trainings • Introduction to Service Connect / Care Connect • Member Files/Eligibility (What to find there) • Provider Files (What to find there) • Creating Reviews • Authorizing Reviews • Managing Your Work Queue • Hospital Diversion Process

  11. Questions?

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