ValueOptions® of California

Welcome to the ValueOptions® of California, Inc. network of participating providers. This Handbook is prepared as a guide to ValueOptions® of California policies and procedures for individual providers, affiliates, group practices, programs and facilities. It provides important information regarding the managed care features incorporated in the ValueOptions® of California provider contracts and reflects the policies and procedures that are applicable to our Knox-Keene product lines.

ValueOptions® of California (VOC) is a wholly owned subsidiary of ValueOptions® and a health care service plan licensed under the Knox-Keene Act to provide mental health and substance abuse (MHSA) and employee assistance program (EAP) services to commercial clients; VOC also provides administrative services to ValueOptions®' administrative service only (ASO) clients. As a Knox-Keene Plan, ValueOptions® of California is strictly regulated by the California Department of Managed Health Care (DMHC). Where there is conflict between ValueOptions®, Inc. requirements and Knox-Keene regulations, this Handbook will reflect the Knox-Keene regulations for ValueOptions® of California business, if more stringent.

To assure services are appropriately monitored and continuously improved for ValueOptions® of California business, ValueOptions® of California has developed and implemented a comprehensive Quality Management Program (QMP). The structure of the QMP encompasses the vision and mission of our organization and complies with the National Committee for Quality Assurance (NCQA), the American Accreditation HealthCare Commission/URAC, and other industry standards. The broad stakeholder involvement approach to the QMP has brought national recognition from several organizations, including The National Alliance for the Mentally Ill (NAMI).

Important Notice

This handbook explains many important aspects of the ValueOptions® of California program. Together, the ValueOptions® of California provider contract, addenda, and the Handbook outline the requirements and procedures that providers must follow to be included in the ValueOptions® of California networks. ValueOptions® of California also maintains a web site at www.valueoptions.com/providers/Network/California.htm. This web site is a vehicle for communicating any changes to this Handbook, member educational materials, news and other online services. ValueOptions®, Inc. maintains a separate handbook for requirements and information regarding your ValueOptions®, Inc. contract. Therefore, in addition to careful review of the information provided in this Handbook, it is important to be familiar with the requirements provided at www.valueoptions.com.

ValueOptions® of California may, by notice, amend or change any or all provisions of the Handbook by providing forty-five (45) business days prior written notice to providers unless the amendment is material and not made in order to comply with a change in state or federal law or accreditation standards. Refer to your ValueOptions® of California participating agreement for information related to Handbook or contract amendments. To the extent that there is an inconsistency between the Handbook and the provider contract, ValueOptions® of California reserves the right to interpret such inconsistency. ValueOptions® of California's interpretation shall be final and binding.

Provider Policies and Procedures

ValueOptions® of California has many policies and procedures that describe specific business practices and operations. If you would like a copy of a policy on a specific topic (i.e. Grievance policy, Confidentiality policies, Independent Medical Review policy, etc.), please contact the ValueOptions® of California Provider Relations Department and identify the specific policy topic you are requesting.

Provider Handbook

  1. Contact Information (PDF)
  2. Going Online with ValueOptions of California (PDF)
  3. Participating Provider Responsibilities (PDF)
  4. Network Credentialing (PDF)
  5. ValueOptions® of California Provider Disputes and Member Grievances (PDF)
  6. Electronic Funds Transfer (EFT) (PDF)
  7. Electronic Provider Summary Vouchers (PSVs) (PDF)
  8. Claims Payment (PDF)
  9. ProviderConnect and Electronic Claims Submission (PDF)
  10. Claims Billing Audits (PDF)
  11. Referral (PDF)
  12. Quality Management Program (PDF)
  13. Utilization Management Program (PDF)
  14. Clinical Criteria Introduction
    1. Clinical Criteria
  15. Clinical Treatment Guidelines
  16. Member Rights and Responsibilities (Posters) (PDF)
  17. Employee Assistance Program (EAP) Affiliates (PDF)
  18. Notice of Privacy Practices (PDF)
  19. Language Assistance Program (PDF)
  20. ValueOptions® of California Glossary of Terms (PDF)

ValueOptions® of California Forms

  1. Provider Dispute Resolution (PDR) Request (PDF)
  2. Provider Dispute Resolution Multiple Requests (PDF)

Administrative Forms

Clinical Forms

EAP Forms