Authorization Process

Providers are encouraged to start with the ValueOptions^® system “Provider Connect” to verify a member’s enrollment and eligibility. 

The member look-up screen requires the following elements:

Member ID (Medicaid number or “Unique ID+ (last 4 digits of the social security number)” in KCPC for AAPS funded members).  If the member has a Medicaid number, you should look up the member under their Medicaid ID and if they are not there you should look them up under their unique KCPC ID with the last 4 digits of the SSN added to the UniqueID. 
Last Name
First Name
Date of Birth
As of Date

Click here to view the Eligibility and Benefits Search Screen

Once the member’s eligibility has been established, the provider or RADAC should proceed with the assessment or CSR to request the needed service.  If the member search shows the member is enrolled but not eligible, then the provider should call the ValueOptions^® Kansas Access line for further information on accessing service authorization.  

KCPC Assessment and Request for Services

There must be a completed assessment in place to request services.  If an assessment has been completed by another agency or RADAC then the file can be obtained from ValueOptions^® with the submission of a member signed release of information sent to ValueOptions^®.  Only a member can sign the release of information.  This process for release of information applies for Transfers from Level (TFL), and Open Continued Stay Reviews (OCSR).  The assessment must cover all six dimensions of the KCPC and the criteria summary page.   The KCPC help section is an excellent guide for assistance on completing the KCPC.  

Requesting Services

When requesting authorization for services you must first have a completed assessment which allows access to the service request/authorization screen in the KCPC.  In the summary notes section of the KCPC request for services, you should enter any and all information you believe was not captured elsewhere in the KCPC.  Additionally you should indicate if this request is for another provider or a transfer from level. From the Request for Services / Authorization screen complete the following steps:

1. Choose the modality.
2. Enter the Service Period Start Date.
3. The Service Period Start Date must be on or after the screening date, except for Social Detox (which can be up to 48 hours prior to the screening date).
4. The Service Period End Date and Continued Stay Review Date will be defaulted based on the level of care. The Continued Stay Review date may be changed if necessary.
5. A primary counselor may be chosen from the Primary Counselor drop down list. If the desired counselors name is not in the list, you will need to close the service request form, add the counselor in the Primary Counselor Screen, then go back into the service request. The primary counselor chosen may be used when billing modalities in the Treatment Billing System.
6. Providers should enter the number of units requested (ValueOptions^® will authorize).
7. Only Providers can access the provider notes section, and only ValueOptions^® can access the VO notes section.
8. Click Save to save the entry.
9. If the member is going to be in more than one type of care at the same time, they should be added here. Click the Add button to get a fresh screen, and click Save when done.
10. A funded member service request can be edited until it is authorized by the VALUEOPTIONS^®. The screen will be locked after authorization.
11. If a mistake is made, ValueOptions^® may make changes after authorization.
12. When all services for the service period have been completed, choose Return. The file will be "Marked to Send" automatically.

ValueOptions^® will review the service request when submitted and based on the criteria make a determination or notify the provider if the services can not be authorized.  The provider will be notified through the KCPC and will be able to track the information on the authorization in Provider Connect. 

Click here to view the Kansas Authorization Summary

KCPC Movement of Member files between Licensed Treatment providers including Discharge/ Transfer from Level and Continued Stay Reviews

There is a difference between a discharge from Your Agency and a discharge from the KCPC system.  You can discharge a member from Your Agency and leave the KCPC open so that the member can access treatment services at another provider in Kansas. This is not called a discharge in the KCPC system, regardless of whether you consider the member discharged from your facility.

To leave the KCPC treatment episode open and active for referral to a different provider there are two options:

1. Transfer from Level to New Provider (TFLtoNP)
   This is only to be used if you are referring the member to a different substance abuse provider at a DIFFERENT Level of Care (i.e. moving from Level 1 at Your Agency to L2.1, L3.1, L3.3 or L3.2D at a new provider).
   
   
2. Continued Stay Review to New Provider (Often called an Open CSR to NP or OCSRtoNP). 
   This is to be used only if you are referring the member to a different substance abuse provider at the SAME Level of Care (i.e. Level 1 to Level 1).

These options are not interchangeable.  The TFL is to be used only when the Level of Treatment is being changed while the OCSR is to be used only when the Level of Treatment is remaining the same. 

You can leave an OCSRtoNP open on the KCPC system if you are recommending that the member access substance abuse treatment on his/her own or with the help of a case worker or care manager after they reach their next residential placement.  This does not mean community self help groups like AA, NA etc.; it is only used if you are recommending treatment at a licensed treatment provider. 

If you know where the member is going after Your Agency, your counselors need to facilitate coordination of care and referral between your agency and the next.  The information regarding who the next provider will be needs to be included in the treatment recommendations on the TFLtoNP or the OCSRtoNP.  When this is received on the ValueOptions^® worklist in the KCPC system, it will be reviewed and will be approved or denied based on the clinical evidence presented.  When it is approved, ValueOptions^® will send Approval to the next treatment provider per your documentation. 

Once the TFL or the OCSR are approved by ValueOptions^®, the episode will become inactive on your local system.  If it is denied, you will be asked in the return documentation to enter the corrected activity that is necessary to move the file.

If a member episode is left open in the centralized statewide database through the use of an OCSRtoNP or a TFLtoNP and the member does not access further tx, the episode file will be automatically discharged after a set amount of time. 

Medical Necessity and Adverse Determinations
If the clinical information does not substantiate the request for services, then upon review by a physician the care will not be certified and the provider will be notified through the KCPC.  The member will also receive a letter informing them that the care was not authorized. 
Following a service denial the member may request an appeal directly or through their provider acting as an agent for the member.  For the guide on seeking an appeal of a service denial, please see the section titled Member Rights and Protections on page 38.  This will provide the complete description of the Appeal Policy and Procedure.

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