Key Points to Remember
- Inpatient Treatment Reports (ITR’s) are not accepted for the accounts managed by the Michigan Engagement Center for higher levels of care such as inpatient and partial hospital programs for both mental health and substance abuse. Requests may be submitted online or by calling the toll free # for the member’s plan.
- Several accounts managed by the Michigan Engagement Center are not required to comply with Federal Mental Health Parity regulations. These exempt plans include a plan that is made up completely of retirees. A retiree plan is not subject to parity if placed in its own ERISA plan separate from the active plan. In order to be exempt, a plan needs to be 100% retiree population with no full-time or part-time employees.
- If an authorization request is submitted online, it automatically goes to the correct engagement center.
- If you are unclear which engagement center handles a member’s account, call the toll free # on the member’s medical insurance card.
- Each account has its own toll free # to reach ValueOptions. Calling the account specific phone # ensures your call will be routed to the correct engagement center.
- The claims address for each member can be viewed by logging into ProviderConnect and conducting a specific member search.
HIPAA (Health Insurance Portability and Accountability Act)
ValueOptions is a HIPAA-compliant organization. Under HIPAA Privacy Rule at 164.514(h) a covered entity prior to making any disclosure permitted under the privacy regulations must verify the identity of a person requesting protected health information (PHI) and the authority of such person to have access to protected health information. If the identity or any such authority of such person is not known to the covered entity, ValueOptions requires that anyone requesting access to PHI be appropriately identified and authenticated. You, or your administrative staff, are identified and authenticated in a number of ways and may be asked for your federal tax identification number (TIN), your national provider identification number (NPI), or physical address as part of this verification process. Having this information available prior to making contact with ValueOptions will expedite your request.