ProviderConnectChapter IIIIntroduction

1

Provider Registration

After a provider has obtained their NPI number

and Medicaid provider number the next

process is to contact Beacon Health Options

EDI help desk 1-888-247-9311

This department will then assist with your user

name and password.

2

ProviderConnect Login

The new user ID and password will be used to

access the Beacon Health Options

ProviderConnect® system.

ProviderConnect can be accessed from here:

https://www.valueoptions.com/pc/eProvider/providerLogin.do

ProviderConnect will allow you, the provider to

enter initial and concurrent authorizations, look

up consumers and enter claims directly into the

Beacon Health Options system.

3

ProviderConnect Login cont’d

4

Enter your Provider ID

Enter your Provider Password

Select Log In

Authorization Request

5

Select “Enter an Authorization Request”

Disclaimer Acknowledgement

6

Select “Next” after reading Disclaimer

Member Search

7

Member Verification

8

Enter the member’s identifying information

Select “Next” after verifying member information

Release of Information Consent

9

1915(i) services are a part of the Maryland mental health services

Select the first choice for option

Select “OK”

Service Information

10

The next several screens are important to ensure that the

correct requested service is submitted

The specific information being requested include:

• Provider Service Location – where records are kept and/or clients

are seen for services

• Requested Service Start Date

• Level of Service: Select “Outpatient / Community Based”

• Type of Service: Select “Mental Health”

• Level of care: Select “1915(i) Services”

• Type of Care: Select the service type from a drop down of

allowable 1915(i) services

Provider Location

11

Enter Provider ID and Select the 1915(i) office location

Select “Next”

1915(i) Service Description

12

This page captures the specific 1915(i) service description a provider is

submitting for review

Date of service, Level of Service, Type of Service, Level of Care and Type of

Care are all required to process each authorization

Authorization Attachment

Please attach a Plan of Care (POC) to your request for services.

POC is a requirement for authorization approval

The POC must be from the Care Coordination Organization (CCO) and must identify

each provider submitting a request for services

Provider goals, agency name and any assigned staff should be included on the POC

13

Type of Services Tab: Contact Inforamation

Provider Contact Information is required in the event additional information is needed

14

Type of Services Tab (cont’d)

Select Provider Service and Location located on slide #12 to access this page

1915i youth will have Medicaid funding and are not “Courtesy Review”

Select V-Value Options as the agency this information is intended

Enter information about the legal guardian

15

Federally Mandated Reporting Data

Complete the federally mandated additional reporting data questions including the

section on disability status

For initial authorization requests, provider may select “Not Available”

16

Authorization Narrative

The narrative box is a place where provider can highlight any additional

information

17

Clinical Criteria

Providers must complete the Clinical Criteria (Hyperlink is highlighted in Red on previous slide #16)

Indicate whether services are for Individual or Group

All sections for the Initial Authorization must be completed: I, II & III

Note: 1915(i) shall replace references made to “RTC Waiver”

18

Clinical Criteria (cont’d)

For Concurrent Service Requests, the Criteria for Ongoing Authorization must include selecting both

A & B choices.

Note: 1915(i) shall replace references made to “RTC Waiver”

19

Diagnosis Tab

This tab is not required

This question should be answered “NO” for all 1915(i) services EXCEPT Respite

20

Diagnosis Tab (cont’d)

Select Behavioral Diagnoses (Use the drop down box to select the appropriate public mental

health system diagnostic code)

If selecting multiple diagnoses list the primary behavioral diagnosis code entered first

21

Diagnosis Tab (cont’d)

Select a Diagnosis Code (Use the drop down box to select the appropriate primary medical

diagnosis)

Select “None or Unknown” if applicable

22

Diagnosis Tab (cont’d)

Select Social Elements Impacting Diagnosis (Select all that apply)

Select “Unknown” if applicable

Use drop down box if completing any Functional Assessment and enter Assessment Score

23

Substance Use Tab

This tab is not required for this type of request

Select Next

24

Individual Plan Tab

This tab is optional and may be used to enter clinical information and treatment goals for the

participant

25

Supported Employment Tab

This tab is not required for this type of request

Select Submit

26

Results Tab

The Results of your inquiry submission for authorization are presented

The authorization requires additional clinical review and is in a “Pended” status

If further information is needed, the 1915(i) Liaison will be in contact with the provider

27

Results Tab (cont’d)

There are Authorization Printing and Downloading Options that are available on the Results Tab

Providers will not be able to contact Beacon to reproduce authorization results

28

Chapter III – Attestation Page

Adhere to the program model as set forth in COMAR 10.09.89.05

Please complete and return to Beacon Health Options email address at

Marylandproviderrelations@beaconhealthoptions.com or fax to Provider Relations at 410-691-4001.

By signing this document, I declare that I have reviewed Chapter III: ProviderConnect Introduction.

_________________________________________________________________

Signature of representative

__________________________________________________________________

Print name and title

__________________________________________________________________

Applicant organization name

Phone: ____________ Fax_______________ Email______________________________

29

Thank You

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