ValueAdded

This is the 193rd 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

ICD-10 Transition—Are You Ready? ..................................... 2

Individual Preferred Provider

Criteria for the Treatment

of Trauma ................................ 3

Upcoming BHRS and

RTF Summits ............................ 4

September is National

Recovery Month ...................... 4

Providers: Seeking Ongoing

Help to Gather Consumer

Feedback ................................. 5

Claims Corner POS Codes.............................. 6 Third Party Liability ................ 7 Coordination of Benefits........ 7

4th Annual TAAG Picnic ........... 8

New! RTF Hold Bed Days

Form ....................................... 8

WPIC Fall Videoconference

Series ...................................... 9

Vol. 17 Issue 7 July 2015

What is a Functional Behavioral

Assessment? A Functional Behavioral Assessment (FBA) is a tool for helping families assess the causes and

results of their children’s behavior problems and ways to change those behaviors. By talking

with families, watching the child in different settings, and reviewing records, a professional can

learn why a child acts up and what to do about it. A behavior plan is then set up with steps to

support the child to change his or her behavior. Parents/caregivers may request a copy of the

FBA to best help their child.

Functional Behavioral Assessments help build behavior plans by:

Identifying problem behaviors and why those behaviors occur

Counting the times the behavior occurs and seeing when it occurs

Checking to see what happens to cause the behaviors

Collecting information by talking to parents/guardians, teachers, other people, and watching the child in many places to learn about the problem behaviors

Finding out if the child can control the problem behavior

Finding out if the child needs to learn new skills to stop the problem behavior

Seeing what happens right before and after the behavior

Identifying better behaviors to get the child what they want or lets them escape

Listing what the parent/guardian,

school, and others can do to stop the problem behaviors

Listing what others are not to do to try to stop the problem behaviors

Seeing what rewards the child for using good behavior and asking important people in the life of the child to use these rewards

Offering tips to help the child learn what “triggers” the behavior and how to successfully avoid or get away from the triggers

Suggesting changing what happens around the child to promote good behavior

Identifying a caring adult that can give the child positive time and support to change behavior

Identifying difficult times for the child and planning for ways to support the child during those times

Providers, please note that the FBA provider audits will soon be starting again. If you

have any questions, please contact your Provider Field Coordinator.

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ValueAdded—July 2015

ICD-10 Transition—Are You Ready?

In compliance with current federal mandates, ValueOptions and Value Behavioral Health of Pennsylvania, Inc. will be transitioning to the ICD-10 coding system on October 1, 2015.

Requirement The U.S. Department of Health and Human Services has issued a rule finalizing October 1, 2015 as the compliance date for all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to transition to using the new ICD-10 code sets. HIPAA-covered entities include:

Providers

Payers

Clearing Houses

Billing Services

Rationale ICD-10 coding system will replace the current ICD-9 coding system. This transition is expected to allow physicians and other healthcare providers to document clinical care more precisely and has the potential to ensure more accuracy around reporting and evaluating medical necessity for services provided. Following are links to resources our provider network will find useful while preparing for the transition.

ValueOptions ValueOptions ICD-10 Resource Portal

CMS Guidance: ICD-10 The Centers for Medicare & Medicaid Services (CMS) has release numerous written and video communications regarding ICD-10. Other information can be found on the CMS.gov website, also listed below. ICD-10 Introduction Fact Sheet CMS ICD-10 Website Sign Up for CMS ICD-10 Industry Email Updates

ICD-10 Training Resources Prepare for compliance with the ICD-10 mandate via ICD-10 general and implementation training. A sampling of industry resources are listed below. American Health Information Management Association (AHIMA) American Academy of Professional Coders (AAPC) ICD-10 Coders Academy This information is intended for general informational purposes. It should not be construed as an endorsement of any organization or product.

3

ValueAdded—July 2015

Individual Preferred Provider Criteria for the Treatment

of Trauma

Value Behavioral Health of Pennsylvania, Inc. (VBH-PA) and our county partners

believe that the treatment of trauma is fundamentally different from traditional

psychotherapy in a number of ways. Many members who seek traditional

psychotherapy are not having their needs met due to a significant history of

trauma. Therefore, trauma providers must have the specialized experience, training,

and supervision beyond that of the traditional psychotherapist. They must be able

to demonstrate significant knowledge about:

Human behavior and development

Comprehensive mental health evaluations/clinical interview

Psychosocial assessment

Specific treatment techniques for specific age groups

Treatment protocols that include Cognitive Behavioral Therapy (CBT), skill building for emotional regulation, and a

Trauma Narrative component

In an effort to develop a preferred provider network, VBH-PA began a workgroup of interested county representatives and

cross-departmental representatives from VBH-PA in 2013. This workgroup adopted criteria for acceptance as a preferred

provider for the treatment of trauma.

The Minimum Standards for Preferred Providers Treating Trauma:

Credentialed with VBH-PA

Licensed and/or licensed eligible professional (LPC, LCSW, LSW, LMFT, Psychologist, Psychiatrist)

Evidence Based Practices—utilizes Trauma-Focused CBT, certification and/or documentation supporting the

completion of a SAMHSA approved training program or course

For practitioners based in the NW3 and SW6 counties, it is preferred that this certification be accomplished

via the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) National Certification Program

Screening Tool —utilizes trauma symptom checklist for adult and child

VBH-PA welcomes the use of additional screening tools but requests that the practitioner submit the tool to

VBH-PA for prior approval. The screening tools used should be culturally sensitive and appropriate.

Clinical Supervision—minimum one (1) time per month, for a minimum of one hour, by a trauma trained

supervisor. VBH-PA prefers that the supervision is provided by a trauma trained and certified supervisor, but it is

not required.

Practitioner must provide documentation of 12 hours of trauma-focused training every two years.

To become an individual preferred provider for the treatment of trauma with VBH-PA, please submit all of the above

information to Andrea Poole, Provider Field Coordinator, at andrea.poole@valueoptions.com or you may call her at (724)

430-1377.

For additional resources please visit the following websites:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) National Certification Program https://tfcbt.org

National Traumatic Stress Network www.nctsn.org

SAMHSA http://www.samhsa.gov/nctic

Child Welfare Information Gateway www.childwelfare.gov

Chadwick Center on Children and Families http://www.chadwickcenter.org

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ValueAdded—July 2015

Upcoming BHRS & RTF Summits

BHRS SUMMITS

(Your choice of two

locations per month.)

September 9—

Courtyard by Marriott

Greensburg, PA

September 11 —

Hampton Inn & Suites

Mercer, PA

December 4—

Courtyard by Marriott

Greensburg, PA

December 11 —

Hampton Inn & Suites

Mercer, PA

RTF SUMMITS

October 9 —

Doubletree by Hilton,

Mars, PA

.

September is National Recovery Month

National Recovery Month (Recovery Month) is a national observance held every September to educate Americans that substance use treatment and mental health services can enable those with a mental and/or substance use disorder live healthy and rewarding lives. Recovery Month celebrates the gains made by those in recovery, just as we celebrate health improvements made by those who are managing other health conditions such as hypertension, diabetes, asthma, and heart disease. The observance reinforces the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover. There are millions of Americans whose lives have been transformed through recovery. Since these successes often go unnoticed by the broader population, Recovery Month provides a vehicle for everyone to celebrate these accomplishments. Each September, tens of thousands of prevention, treatment, and recovery programs and facilities around the country celebrate National Recovery Month. They speak about the gains made by those in recovery and share their success stories with their neighbors, friends, and colleagues. In doing so, everyone helps to increase awareness and furthers a greater understanding about the diseases of mental and substance use disorders. Now in its 26th year, Recovery Month highlights the achievements of individuals who have reclaimed their lives in long-term recovery and honors the treatment and recovery service providers who make recovery possible. Recovery Month also promotes the message that recovery in all of its forms is possible and encourages citizens to take action to help expand and improve the availability of effective prevention, treatment, and recovery services for those in need.

Recovery Month 2015 The theme for Recovery Month 2015 is “Join the Voices for Recovery: Visible, Vocal, Valuable!” The 2015 Recovery Month theme highlights the value of peer support in educating, mentoring, and helping others. The theme invites individuals in recovery and their support systems to be catalysts and active change agents in communities and in civic and advocacy engagements. It encourages individuals to start conversations about the prevention, treatment, and recovery of behavioral health conditions at earlier stages of life. Currently, more than 200 federal, state, and local government entities, as well as nonprofit organizations and associations affiliated with prevention, treatment, and recovery of mental and/or substance use disorders, comprise the Recovery Month Planning Partners’ group. The Partners assist in the development, dissemination, and collaboration of materials; promotion; and event sponsorship for the Recovery Month initiative. Materials produced for the Recovery Month observance include print, Web, television, radio, and social media tools. These resources help local communities reach out and encourage individuals in need of services, and their friends and families, to seek treatment and recovery services and information. For more information and materials, visit: http://www.recoverymonth.gov

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ValueAdded—July 2015

What are C/FST’s?

The Pennsylvania Department of Human Services (DHS) requires primary contractors to implement a comprehensive approach for measuring the satisfaction of HealthChoices behavioral health consumers and family members. This system includes Consumer/Family Satisfaction Teams (C/FST). C/FST members have face-to-face discussions with consumers/family members concerning, but not limited to, services received, access, delivery, outcomes, choice, treatment options, timeliness and convenience of service delivery. The focus of the C/FST program is soliciting input and providing consumer information to the HealthChoices program in order to develop quality improvement actions. For the purpose of the HealthChoices program, C/FSTs are agents of the primary contractor and have the delegated authority to collect and disseminate the needed information. Providers are required to cooperate with the C/FSTs within confidentiality guidelines.

As a provider, you are interested in assuring the consumers you serve are satisfied with your services and are achieving their treatment goals. Each county has a Consumer/Family Satisfaction Team. The teams are very active, primarily with larger providers. They are continually trying to reach more consumers. VBH-PA would like to remind all providers, particularly smaller providers and individual practitioners, to participate in the Consumer/Family Satisfaction Team process. You can do this by:

Reminding consumers you serve about the Consumer/Family Satisfaction Teams. The phone numbers for the teams of each county are listed below.

Working with the Consumer/Family Satisfaction Teams when they contact you to identify consumers you serve who may be interested in completing a survey.

Providing Consumer/Family Satisfaction Teams with comfortable private space for interviews to ensure an environment in which behavioral health and/or substance abuse consumers and their families feel free to express any concerns they may have.

VBH-PA and the Consumer/Family Satisfaction Teams would like to thank the providers who actively participate and would encourage providers who have not had the opportunity to participate to contact the team in your county for more information.

Armstrong

(724) 548-1151

Beaver

(724) 775-7650

Butler

1-888-223-7620

Cambria

(814) 254-4342

Crawford

(814) 336-2152 or

1 (800) 670-7132

Fayette

(724) 438-6738

Greene

(724) 852-5395

Indiana

(724) 465-2099

Lawrence

(724) 657-0226

Mercer

(724) 283-5553 or

1 (888) 223-7620

Venango

(814) 678-7766 ext 139

1 (800) 611-6217 ext 139

Washington

(724) 225-9550 x405

Westmoreland

1-800-871-4445

County C/FST Phone Numbers

Providers: We Need Your Ongoing Help to

Gather Consumer Feedback

Place of Service Codes Reminder

Per the Behavioral Health Services Reporting Classification Chart, the following POS codes have been

removed: 55, 53, 55, 62, and 71. These POS codes will no longer be accepted.

Value Behavioral Health of Pennsylvania, Inc. (VBH-PA) would like to remind providers to verify the

correct Place of Service (POS) Codes before billing. VBH-PA service authorization requirements for all

VBH-PA HealthChoices’ covered services are found on the Covered Services Grid at http://www.vbh-

pa.com/provider/info/pr/PrvCovSvcGrid.pdf and/or the Authorization Requirements Grid in the

Utilization Management section of the Provider Manual: http://www.vbh-pa.com/provider/info/

prvmanual/files/Authorization-Requirements.pdf.

Please make sure to verify the correct POS codes on a frequent basis.

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ValueAdded—July 2015

Place of Service (POS) Code Billing Requirements

All HealthChoices claims billed via an 837 Professional File or CMS-1500 require a valid POS Code for

adjudication. All valid POS codes are listed with the service code/modifier combination are reimbursable by

VBH-PA. Please note that outpatient services conducted at a school that is a licensed outpatient clinic

satellite of a facility should be coded POS 49, not POS 03. This information can be reviewed at: http://

www.vbh-pa.com/provider/info/pr/PrvCovSvcGrid.pdf. Listed below are the valid POS codes and their

descriptions.

POS Place of Service

Description POS

Place of Service

Description

03 School 49 Independent Clinic

11 Office 50

Federally Qualified Health

Center

12 Home 52 Psychiatric Facility - PH

15 Mobile Unit 54 ICF/MR

21 Inpatient Hospital 56 Psychiatric RTF

22 Outpatient Hospital 57

Non-Residential Substance

Abuse Treatment Fac

23

Emergency Room -

Hospital 65

End-Stage Renal Disease

Treatment Facility

24

Ambulatory Surgical

Center 72 Rural Health Clinic

31 Skilled Nursing Facility 81 Independent Laboratory

32 Nursing Facility 99 Other POS

7

ValueAdded—July 2015

Third Party Liability VBH-PA is the payor of last resort. The Third Party Liability (TPL) information contained

within ProviderConnect should be reviewed at the time services are delivered. Providers

must follow the primary insurance carrier’s procedures regarding authorization/

certification, timely filing, and claims submission. If you do not provide an Explanation of

Benefits from the primary carrier with your secondary claim, the claim will be denied by

VBH-PA.

Listed below is helpful information to reference when providing and billing services to

VBH-PA that require an explanation of benefits from the primary insurance carrier.

Providers must always confirm the following information with the member prior to service

delivery:

Does the member have private insurance?

If yes, obtain a copy of the front and back of the private insurance card.

Determine if there is a carve-out responsible for managing behavioral health

benefits.

Contact private insurance plan (carve-out) to obtain authorization (if required).

Submit claims to the private insurance plan within their timely filing guidelines.

Coordination of Benefits All primary insurances must be billed prior to submitting the claim to VBH-PA.

Providers and members must follow the primary carrier’s requirements.

Providers who are not in-network/non-participating with the primary carrier’s

network should request an out-of-network arrangement with the primary carrier or

redirect the member to the primary carrier for referrals to an in-network or

participating provider.

VBH-PA considers the Patient Responsibility/Member Liability/Patient Liability

(coinsurance/co-pays/deductibles) on the Explanation of Benefits and will only

pay up to the VBH-PA contracted rate in most cases.

Inappropriate Primary Carrier Denials

Primary Carrier requirements were not followed

Primary Carrier denial for no authorization

Primary Carrier denial for not meeting timely filing requirements

Primary Carrier denial for rendering provider not being contracted/

credentialed

Please contact the VBH-PA Customer Service Department at 1-877-615-8503 if you have

any questions. Customer Service is available for assistance Monday through Friday from

8:00 a.m. – 5:00 p.m. EST.

8

ValueAdded—July 2015

As discussed at the RTF Summit in April, there is a new form that

was developed to help both RTF providers and VBH-PA staff to

better track “hold bed days.” The form was presented at the

Summit and has been placed on the VBH-PA website for your use.

It is on the Provider Forms webpage: http://www.vbh-pa.com/

provider/prv_forms.htm#clinum. Look under Clinical/Utilization

Management Forms, Authorization Forms, and the RTF Request

for Hold Bed Days form can be printed for your use.

We hope that by utilizing this form, it will help to ensure that you

are able to have your authorizations adjusted quickly and allow for

more timely claims payment.

RTF Hold Bed Days Form—New!

Join Us!

4th Annual “TAAG” Picnic

For Transition Age Youth 16—29 years

“Camp TAAG” Create Your Own

Personal Camping Adventure!

Where: Family Retreat Center

1100 Freeport Road, Mars, PA

When: Wednesday, August 12, 2015

Time: 10:30 a.m. to 4:00 p.m.

REGISTRATION

Would you like to attend this year’s Picnic?

Click here for the Registration Form.

VENDORS

Would you like to exhibit at this year’s Picnic?

Click here for the Exhibitor Registration Form.

Please contact Karan Steele with any questions at (724) 744-6537 or at

karan.steele@valueoptions.com.

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ValueAdded—July 2015

2015 WPIC Videoconferences Fall Series!

VBH-PA is pleased to announce that our Engagement Center will be a videoconferencing

site for the WPIC Office of Education and Regional Programming 2015 fall

videoconference series. These programs are free of charge and there are NO fees for

continuing education credits. The videoconferences are held from 9:00 a.m. to 11:00 a.m.

in the Walnut Room at VBH-PA’s Trafford Engagement Center. For CEU information,

registration information and complete descriptions of these trainings, please view

“Upcoming Trainings” on our Provider Training webpage.

Upcoming Videoconferences*

September 16—Evidence Based Treatments for Post-Traumatic Stress Disorder: An Overview

October 14—ECT in Late Life Depression

November 18—Strategies for Working with Reactive Attachment Disorder (RAD) Children in

Adoptive, Residential and Family of Origin Homes

December 9—Mental Health and Homelessness

Registration:

To register for these trainings, please visit the ValueOptions Provider Trainings Web

page. Select Pennsylvania from the state dropdown list (DO NOT change any of the

other fields) and then click on Select. Scroll down the screen and put a check mark in

the box next to the event(s) and then hit Register. Phone-in registrations will not be

accepted.

*Please Note: These videoconferences are NOT webinars. You must be in attendance at

the Trafford Engagement Center to view these videoconferences. VBH-PA is one of

many sites offering this opportunity. Please click here to view all locations offering this

videoconference series. To register with another location, please contact the coordinator for

that site.

Suggestions or ideas for

articles that you would

like to see published in

ValueAdded can be

faxed to Kim Tzoulis, Val-

ueAdded Editor, at (724)

744-6363 or emailed to

kimberly.tzoulis@

valueoptions.com

Articles of general im-

portance to the provid-

er network will be con-

sidered for publication.

Value Behavioral Health

of PA, Inc.

520 Pleasant Valley Rd

Trafford, PA 15085

Phone: (877) 615-8503

Fax: (724) 744-6363

www.vbh-pa.com

Contacting VBH-PA

Provider Relations has

never been easier! Click

on the Webmaster email

address below to send an

email:

vbhpawebmaster@value

options.com