CHAPTER 2
PARTICIPATION IN THE STATE PUBLIC BEHAVIORAL HEALTH
SYSTEM
General Description
Any practitioner who is authorized under the Health Occupations Article, according
to Maryland state regulation (COMAR), to provide behavioral health services
(inclusive of both specialty mental health service providers or substance use disorder
service programs), a provider who is approved or licensed under the Maryland
Department of Health and Mental Hygiene Administration Regulations, HSCRC
regulated services, or Federally Qualified Health Centers, may be a provider in the
Public Behavioral Health System.
Providers can access information regarding participation in the Public Behavioral
Health System (PBHS) at:
http://www.dhmh.maryland.gov/mha/SitePages/infoforproviders.aspx
All providers are required to regularly review ValueOptions® Maryland and the
Department of Health and Mental Hygiene’s Behavioral Health Administration
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm
website for Policy and Procedure updates or changes. It is the responsibility of the
provider to be informed of all information affecting the delivery and payment of
PBHS services. Providers may also access their local Core Service Agency (CSA)
and/or Local Addiction Authority (LAA) for issues regarding local services and
supports. A complete list of CSA and LAA are listed within the ValueOptions®
Maryland website at http://maryland.valueoptions.com/
2.1
Participation in the Public Behavioral Health System Network (All
Providers)
The PBHS requires all providers to be in good standing. All providers delivering
Medicaid reimbursed services are required to have an active Medicaid number.
Providers delivering more than one type of approved or licensed service, under the
Behavioral Health Administration regulations, COMAR 10.21 and 10.47 require a
separate Medicaid and NPI number for each Medicaid service and service location
(e.g., separate numbers for Opioid Maintenance Treatment Programs and Outpatient
Mental Health Centers and Psychiatric Rehabilitation Programs).
If a provider wishes to confirm whether they have an active Medicaid number they
may do so by contacting: marylandproviderrelations@valueoptions.com. For
providers approved under COMAR 10.21 or 10.47, BHA regulations delivering nonMedicaid services, a separate provider agreement between the provider and BHA is
required after the program receives OHCQ approval. ValueOptions® Maryland will
pay providers based on this provider agreement. ValueOptions® Maryland does not
credential or contract directly with PBHS providers.
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm
In order to become a provider within the PBHS, providers must first enroll in
Maryland Medicaid. To receive a State of Maryland Department of Health and
Mental Hygiene Medical Care Program Provider Application, contact DHMH
Provider Enrollment: 410-767-5340. On-line Provider Enrollment in the PBHS can
be accessed at: https://encrypt.emdhealthchoice.org/emedicaid
Providers must then register with ValueOptions® Maryland through the
ProviderConnect System in order to complete authorizations to submit claims for
reimbursement. To register with ValueOptions® Maryland providers should call 1800-888-1965 and follow the prompts provided.
All PBHS providers are credentialed and contracted by the DHMH. The provider
information in the DHMH system (MMIS II) is downloaded to ValueOptions®
Maryland weekly. Providers are required to comply with state and federal laws and
regulations, including all applicable Medicaid and BHA regulations. All services
require preauthorization except emergency services, no exceptions will be granted.
Note: The MA number must be a valid provider type and status. See Appendix D,
State Approved Medicaid Provider Types for the PBHS.
2.2
Change of Status or Address
Because ValueOptions® Maryland does not credential providers, we do not
update provider information in our authorization and claims systems. It is the
responsibility of the provider to notify DHMH as soon as possible, but no later than
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm
30 days after the effective date of the change. Behavioral Health Programs, Groups,
and Outpatient Mental Health Clinics should contact
DHMH.BHenrollment@Maryland.gov to obtain direction of what is required by
Medicaid to update the provider record. Individual practitioners can update their
records by contacting the DHMH, Provider Enrollment Department, at (410) 7675340. Provider Enrollment must be made aware of any of the following changes:
 Provider’s name and the name(s) of the provider’s practice, facility, and
program.
 Tax identification number and billing information.
 Street address(es), city, state, and zip.
 Telephone number(s), fax number(s), beeper or pager numbers, and e-mail
addresses.
 Copies of new or updated licenses, authorizations, or program approvals.
ValueOptions® Maryland will update its systems to reflect the information changes
made through Provider Enrollment. Please note that changes to a provider’s
information could take up to 3 weeks to populate in the ValueOptions® Maryland
system.
2.3
Provider Terminations
Notifications
A provider must notify the DHMH Provider Enrollment (410-767-5340) within 24
hours upon the occurrence of any of the following:
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm
 Revocation, suspension restriction, termination, or relinquishment of any
of the provider’s licenses, authorizations, program approvals, or
accreditations, whether voluntary or involuntary.
 Any indictment, arrest, or conviction for felony charges or a criminal charge
other than traffic offenses.
 Revocation, suspension, restriction, termination or relinquishment of medical
staff membership or clinical privileges at any healthcare facility.
Voluntary Termination
If a provider decides to no longer participate in the PBHS, the provider must notify
DHMH Behavioral Health Unit by emailing: DHMH.BHenrollment@Maryland.gov,
or call Provider Enrollment directly at 410-767-5340, and must also contact
ValueOptions® Maryland Customer Service (1-800-888-1965, option 3).
Involuntary Termination
If a provider loses his/her licensing, certification, approval, or otherwise becomes
ineligible, DHMH will inform the provider that he/she is terminated from
participation in the PBHS. ValueOptions® Maryland receives provider terminations
in the weekly downloads from DHMH.
2.4
Out-of-State Emergency/Urgent Care (Medical Assistance Benefit Only)
A participant may receive care from a non-registered provider in an emergency or
urgent situation when traveling out-of-state.
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm
If the provider does not have an active Maryland Medicaid number, the individual or
organization must apply for one to receive claims reimbursement. An NPI is also
required. Please see section 2.1 for additional information on how to enroll in
Maryland Medicaid and register within the ValueOptions® Maryland System.
2.6
Participant Referral
Description
Medicaid (MA) and Non-Medicaid participants who contact, or are referred to,
ValueOptions® Maryland for behavioral health services, will be referred to a provider
or providers according to the policies outlined below.
Policies
Open Referral Process
Referrals may be initiated by the participant, the participant’s primary care provider
(PCP), a family member, or legal guardian.
Participant Choice
The Department of Behavioral Health and Mental Hygiene values participant choice.
Participant wishes and needs drive the referral process. Participants will be given a
choice of providers.
Participant Preferences
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm
Participant preferences can be identified in the following areas:
 Provider location
 Transportation to provider office
 Provider office hours
 Gender of provider
 Culture and communication
Participant Needs
Participant needs will be identified in at least the following areas:
 Clinical
 Child or adolescent
 Geriatric
 Deaf or hard of hearing
 Language
 Veterans
ValueOptions® Maryland Provider Manual
Copyright 2015: http://maryland.valueoptions.com/index.htm