ValueOptions of Kansas Provider Handbook Supplement (PDF)

ValueOptions of Kansas Provider Handbook Supplement
Note: Please reference the ValueOptions Participating Provider Handbook to review policies and procedures as well as administrative processes germane to all ValueOptions providers.

Introduction

• Welcome
• Purpose
• Background
• Evolutionary Process
• ValueOptions of Kansas Service Center
• Online Provider Services

Eligibility

• Categories of Eligibility for T-XIX
• SAPT Block Grant and Eligibility

Services

• Covered Services
• Services NOT Covered
• Service Planning and Service Center Oversight
• Debarment and Suspension

Utilization Management

• Overview
• Medical Necessity
• Standard Timelines for Determination of Medical Necessity
• Clinical Criteria
• Ensuring Safety Through Adequate Discharge Planning for Youths
• Ensuring Safety Through Adequate Discharge Planning for Adults

Authorizations

• Requesting Authorizations
• Pre-certification
• Clinical Department Hours of Operation
• Authorization Process

Claims
Note: There is a separate instructional manual for billing information

• Claims and Block Grant Reimbursement Request Information
• Claims and Block Grant Submission Requirements
• Claims and Block Grant Submission Policy
• Electronic Media Claim Submission (EDI and Single Claim Submission)

Member Rights and Protection

• Members are Not Held Liable
• SA-PIHP Grievance and Appeals System Requirements
• SA-PIHP Grievance Process
• SA-PIHP Appeals Process

Quality Management

• Role of Participating Provider
• Scope of the ValueOptions’ Quality Management Program
• Quality Improvement Activities/Projects
• ValueOptions’ Annual Quality Management Workplan
• Annual Evaluation of ValueOptions’ Quality Management Plan

Glossary of Terms