Horizon New Jersey (NJ) Health Medicaid Managed …

1 Horizon New Jersey (NJ) Health Medicaid Managed long Term services and Supports (MLTSS). provider frequently asked Questions (FAQ). This FAQ document will continue to be reviewed and updated frequently in order to provide the most current and pertinent information. GENERAL IMPLEMENTATION TRANSITION QUESTIONS. Q. When will ValueOptions begin to administer the behavioral Health benefits for Horizon NJ. Health MLTSS? A. Effective July 1, 2014, Horizon Behavioral Health selected ValueOptions to manage the behavioral Health benefits for members covered by Horizon NJ Health and enrolled in MLTSS.

2 Q. How do I contact Horizon Behavioral Health and/or ValueOptions with a question related to MLTSS on and after July 1, 2014? A. Although the phone numbers to contact Horizon Behavioral Health regarding MLTSS remain unchanged, there are some additional contact methods. Please refer to the following : Inquiry Type Contact Method provider Relations, Phone: Credentialing and 1-800-397-1630 (8 am - 8 pm ET Monday . Contracting Questions Friday). E-mail: Authorizations and Care Horizon MLTSS Call Center Management Phone: 800-682-9094. (8 am 5 pm ET Monday-Friday/Central Night services will take calls from 5 pm 8.)

3 Am for Care Management). ProviderConnectSM. Claims Phone: 855-777-0123. (8 am 5 pm ET Monday Friday). Appeals, Records, etc. Mail Request to: Appeals Department PO Box 783. Latham, NY 12110. Q. What is MLTSS? A. MLTSS is a set of services and supports for individuals who meet specific clinical, categorical and financial criteria, and are designed to support a member in maximizing their ability to live independently. It replaces many of the waiver programs in NJ and transfers management of the programs to Managed Care Organizations as of July 1, 2014. Q. What are the member eligibility criteria for MLTSS?

4 A. To be qualified for MLTSS, members must meet the following criteria: Members must meets Medicaid Guidelines for financial eligibility Age must be 65 years or older Members are blind or disabled If under age 65, members must be determined blind or disabled by the Social Security Administration or the State of New Jersey Members must meet clinical criteria based upon assessment with the NJ Choice Q. What are the member exclusion criteria? A. Individuals in the following categories are not eligible to enroll in MLTSS: Members with a Division of Developmental Disabilities Community Care Waiver People with Pervasive Developmental Disabilities PACE Program beneficiaries Persons enrolled in Dual Eligible Special Needs Plans Fee-for-service Medicaid beneficiaries who are in a Nursing Facility on or before 7/1/14.

5 AUTHORIZATIONS. Q. Will prior authorization be needed for Behavioral Health MLTSS benefits? A. Prior authorization is needed for all Behavioral Health MLTSS benefits, including: Acute Inpatient *. Partial care/partial hospitalization *. Adult mental Health rehabilitation Outpatient therapy services *. Opioid treatment services Behavioral Health homes *For mental Health and dual diagnosis only Q. What is the process to request an authorization? A. To request an authorization or referral, or ask a clinical-related question , we recommend providers submit their request through ProviderConnect, ValueOptions' secure and HIPAA- compliant provider portal.

6 Providers can also request an authorization by calling l 800-682-9094, 8 am 5 pm ET Monday-Friday. Central Night services will take calls from 5 pm 8 am for Care Management inquiries. PROVIDERCONNECTSM. Q. What is ProviderConnect? A. ProviderConnect is ValueOptions' secure and HIPAA-compliant provider portal that enables in network providers to conduct online authorizations and other related transactions accurately and efficiently. Q. What types of transactions can I conduct using ProviderConnect? A. Horizon MLTSS providers will have the ability to verify member eligibility, view authorization statuses, download and print authorization letters, and enter or review referrals authorized by ValueOptions.

7 Q. How do I register for ProviderConnect? A. New and current ProviderConnect users need to fax a completed Account Request form to 1-866-698-6032. Providers who already have a ProviderConnect account need to submit a new form to request an additional login id to access Horizon member information. Horizon providers need to mark the box for Horizon Behavioral Health Authorizations. Registering for ProviderConnect requires a provider id. If you do not know their provider ID, contact the provider services Line at 1-800-397-1630, 8 8 , Monday through Friday. Q. Will each of our providers in our facility be required to have an individual login to access ProviderConnect?

8 A. It is recommended that each user have his/her own login, and password and that logins and passwords are not shared. Q. If I am not in network provider , will I still be able to access and use ProviderConnect? A. If you are not an in network provider , you will not be able to submit authorization requests via ProviderConnect. All other functionality should be available. Q. What types of ProviderConnect training are available? A. There are numerous training resources on ProviderConnect available in the provider section of These resources include a free online demonstration, user guides, video tutorials and a listing of upcoming webinars.

9 Additionally, customized training is available for you and/or your office. CARE MANAGEMENT. Q. Who do I contact with any care management inquiry? A. For all care management inquiries, contact 800-682-9094. Licensed care management staff is available 24 hours a day/seven days a week for referral and Higher Level of Care (HLOC). requests. Q. What are the appointment standards for MLTSS providers? A. For emergent and urgent appointments, providers are required to schedule an appointment with a member within 48 hours of the request. For routine appointments, providers are required to schedule an appointment within 30.

10 Calendar days of the request. Q. What clinical resources are available for MLTSS providers? A. Providers can access ValueOptions Medical Necessity criteria, treatment practice guidelines and other related clinical information on the provider section of Q. What is the procedure for reporting critical incidents? A. Any critical incident must be reported by contacting 800-682-9094. Qualifying critical incidents include: Unexpected death of a member ( relatively healthy member choked while being fed by their caregiver). Missing person or unable to contact Suspected or evidenced physical or mental abuse (Including seclusion and restraints, both physical and chemical).