Friday, April 04, 2008

Value Options: the authorization agency for Medicaid who can't even get their online forms straightened out

April 4, 2008

Dear Mr. Benton and Tara Larson of NC DHHS:

I believe that Ms. Larson's duties are associated with overviewing Value Options.

I find it vexing that I have to do my job and try to do Value Options' job also.

Value Options has the incorrect form for authorizations under (Providers) 'Forms' at its website, while in another part of their website, (Providers) 'Network Specific', the company has the correct authorization form.

Why are the authorizaton forms a critical matter? If, for adult Medicaid clients, after 8 sessions, no authorization in place, the provider will not be paid if the provider continues to see the client, assuming that Value Options will authorize sessions (as they have always done in the past).

Therefore, any savy provider would, well in advance, submit the authorization request. I did that. I did it in exactly the same manner as I have for the past several years. Every other year it worked fine. This year it did not. Moreover, I used the current form online at ValueOptions.

In trying to figure out what had taken place, a process which took me a couple of hours of unpaid time, I called Value Options today at their provider number. I spoke with a 'Jennifer' at 4:50, Friday afternoon, April 4, 2008.

I had called earlier and been informed that my authorization request for two Medicaid clients had been rejected----which was a surprise to me as I had never received any paperwork on the matter.

That earlier person at the Value Options Provider line stated that I had not entered in my Medicaid Provider number. I thought: strange. I went to check my paperwork, the form taken from online at Value Options.

Here is that form and I bet that within a week's time, this incorrect form will have been removed from the Value Options website. However, that is because I have taken time to do Value Options work for them and they have been sufficiently embarassed.

I looked at the form I had filled in re: my 2 Medicaid clients, submitted in February, 2008, after I spoke with that person. There is no place on the form (Value Options/Flrms/Clinical/ORF2 is the pathway online) for the provider's Medicaid provider number.

Neither is there a place for any other determining provider number, such as the NPI number.

There is, however, on line 11, on the left hand side of the one page authorization form entitled "Outpatient Review Form (ORF 2) a place something called "VO Provider # (if known)." At the bottom of that one page, in the right hand corner, is this : "Value Options 2005 Rev. 1.03.08"

Thus, it appears that the form was reviewed by Value Options January 3, 2008, and it remains online, the wrong form, for providers to submit and never hear a word about their submissions.

There is no such thing as a 'VO Provider #.' Therefore, the person creating the form, employed by Value Options, had no idea what they were doing.

The correct form is here, which Jennifer identified as I talked w/ her on the phone : (Path: Value Options/providers/network specific/nc Medicaid/ ORF2).

Please note that both of the forms online at Value Options are stated to be the 'ORF2 Form', the form utilized to request authorization to see Medicaid clients.

After speaking with 'Jennifer', I left a specific meessage on Jane Harris's voice mail. She is termed on that voice mail to be a supervisor associated with Provider Relations.

I had asked 'Jennifer' what was the mailing address for Jane Harris. 'Jennifer' stated there was no address. Neither could 'Jennifer' give me Mr. Harris's direct extension when I asked for it.

Mr. Benton: will you please ease the difficulties of being a mental health provider, allowing us to work with clients, by creating a contract with a company that we can work with and who responds to provider concerns?

Thank you.

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville, NC


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