First Coast Advantage Central (FCAC) Behavioral Health Services
Frequently Asked Questions
About FCAC Behavioral Health Services

Who administers behavioral health services for FCAC members?
ValueOptions® is the comprehensive behavioral health benefit administrator for FCAC.
ValueOptions is responsible for administering all aspects of behavioral health services for the First
Coast Advantage Central Provider Service Network.

What is the transition benefit plan for new FCAC members whose providers are not
credentialed/contracted with ValueOptions?
New FCAC members who are in active treatment with a provider, who has declined network
participation or has not completed the necessary application, credentialing and contracting
processes with ValueOptions, may elect to continue authorized treatment with the provider for a
period up to 120-days. If a patient chooses to remain under your care after the transitional 120-day
period, services will not be covered.
Authorization for Care

Can members self-refer for behavioral health services or do they require a referral from their
Primary Care Physician?
Members may self-refer to any in-network provider for behavioral health services. However, it is the
responsibility of the behavioral health provider to obtain authorization for services rendered to the
member.

If I received authorization for Inpatient treatment from the members’ previous plan and the
member has not been discharged, will I need to reauthorize the inpatient stay with
ValueOptions?
If you are treating a member at an Inpatient level of care and previously received authorization for
treatment from another entity prior to the members’ effective date with FCAC, you will need to call
ValueOptions at 855-627-0390 to register the admission and then to review until discharge and/or a
lower level of care is needed. At the point any member needs a step-down level of care; you must
contact ValueOptions to preauthorize this care.

Does ValueOptions require review for inpatient services and higher levels of care?
All Inpatient and higher levels of care require review by ValueOptions. If you are a participating
ValueOptions Florida Medicaid provider requests for continued stay can be submitted online at
www.valueoptions.com through the ProviderConnect portal or telephonically with a Clinical Care
Manager by calling 855-627-0390. All non-network providers must contact ValueOptions telephonically
in order to receive authorization.
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All requests for authorization of continued stays should be made in advance of the expiration of the
current authorization so that no lapse in services occurs. Please note that it is the provider’s
responsibility to contact ValueOptions to request continued stays or concurrent reviews.
Does ValueOptions require authorization for outpatient services?

Currently, ValueOptions requires that all outpatient services be preauthorized. If you are a participating
ValueOptions Medicaid provider a request for authorization can be completed through the
ProviderConnect portal at www.valueoptions.com or telephonically at 855-627-0390. All non-network
providers must contact ValueOptions telephonically in order to receive authorization.
ValueOptions Network Participation (Contracting and Credentialing)

I currently participate with ValueOptions what do I have to do?
To participate in the ValueOptions Florida Medicaid Network, you are required to have a
ValueOptions Practitioner or Facility Agreement which includes the appropriate Medicaid Exhibits
and Addendums. ValueOptions has issued amendments to our participating providers with
information and instructions regarding the addition of the Medicaid network to their current
commercial Agreement. If you did receive an amendment, nothing further is required for you to
participate in the network at this time. If you did not receive an amendment, please contact the
Provider Relations Department at (800) 808-0832 ext 327223 or 327229 for more information.

If I am not a participating Florida Medicaid provider, am I still eligible to participate in the
ValueOptions Florida Medicaid Network?
Providers who are not participating in the Florida Medicaid program will be required to complete and
submit the Florida Medicaid Managed Care Treating Provider Registration form in order to participate in
the ValueOptions Florida Medicaid Network. Please visit the below link to access and complete the
registration form.
http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/Public%20Misc%20Files/MCO%20Tre
at%20Prov%20Reg%20Rev%20081709.pdf

What will happen if I have a ValueOptions commercial Agreement but elect to opt-out of the
ValueOptions Medicaid Network?
You will only be considered a network provider for the commercial network and will not be eligible
to treat members participating in the ValueOptions Medicaid network.
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
I do not participate in any of the ValueOptions networks. How do I join?
Please visit www.valueoptions.com/ providers/ network specific page, select First Coast Advantage
Central, look under Forms & Other Important Information, select and complete the Request for
Participation form or contact the Provider Relations Department at (800) 808-0832 ext 327223 or
327229 for more information.

What are the fee schedules for the First Coast Advantage Central behavioral health program?
The fee schedules will be enclosed in the invitation to join our network. The fee schedule details
the payment (by CPT Code) that you will receive for providing behavioral health services to the
First Coast Advantage Central membership.

Do I have to be credentialed by ValueOptions?
Yes, all providers must be credentialed in order to participate in the ValueOptions network.
ValueOptions Online Services

What online services does ValueOptions offer?
ValueOptions has on-line services to provide added convenience for our members and providers.
ProviderConnectSM is a self-service tool available 24/7 that gives you access to the following
features: single and multiple electronic claims submission, claims status review (for both paper and
online submitted claims), eligibility status, your provider practice profile, and correspondence
(which includes authorizations). Find more information about ProviderConnectSM on
www.ValueOptions.com.

Can I submit my claims electronically to ValueOptions?
Yes, ValueOptions encourages electronic submission. CMS 1500 and UB-04 electronic
submissions are accepted according to guidelines contained in the ValueOptions EDI materials
found on www.ValueOptions.com. If you are interested in electronic claim submission, please
contact our ValueOptions Electronic Claims Specialist at 888-247-9311. We strongly encourage
providers to submit claims electronically for the efficiencies gained by both providers and in claims
processing.

What paper forms can be used for claims submission?
Providers are required to bill on standard CMS 1500 and UB-04 forms. Red ink forms should be
used as these can be scanned, which expedites the claim entry into the claims system. The UB-04
Form can only be used for inpatient and alternative levels of care for mental health and substance
abuse, not outpatient professional mental health services. The CMS 1500 form should be used for
outpatient professional services.
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
Does the ValueOptions electronic claims format work with other claims clearing houses?
Please contact our ValueOptions Electronic Claims Specialist at 888-247-9311. Please note:
ValueOptions does not reimburse for provider expenses associated with electronic claims
submission.

When ValueOptions authorizes care is the authorization an automatic guarantee of payment for
services rendered?
No, authorization of services is not a guarantee of payment. Payment depends on a number of
factors including member eligibility, provider contract status, and benefit limits at the time care is
rendered.

As an individual practitioner, billing outpatient services, do I need to include the provider
number on my claims?
We strongly recommend billing electronically, either via EDI or our web-based direct claim
submission. If submitting on paper, outpatient professional services must be billed on a CMS1500 form and include the billing and rendering providers’ NPI, and Tax Identification number. The
following fields are required: NOTE: billed lines are limited to ten (10) per claim form
CMS-1500 required fields:
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Insured's ID number
Patient's name
Patient's birth date and gender
Insured's name
Patient's address, city, state, zip code and telephone number
Patient's relationship to the insured
Insured's address, city, state, zip code and telephone number
Patient status – married / single
Other Insured’s name, if there is other coverage
Is the patient’s condition related to: Employment? Auto accident? Other accident?
Other Insured’s date of birth – if there is other coverage
Is there another health benefit plan?
Diagnosis or nature of illness or injury - ICD-9 diagnosis code(s) - use HIPAA Compliant Codes
Dates of service
Place of service
Procedures, services or supplies - use HIPAA Compliant CPT/HCPCS codes
Procedures, services or supplies modifier
Diagnosis pointer
Charges
Days or units
Rendering Provider NPI
Federal Tax ID number and type
Total charge
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Signature of physician or supplier including degrees or credentials
Name and address of facility where services were rendered
Physician's/supplier's billing: name, address, zip code and phone number. Billing Provider's
NPI
In addition, please visit www.ValueOptions.com for a complete list, instructions for completing the
CMS 1500 form, and more information on proper billing procedures.

As a facility, how do I bill professional services?
Outpatient professional services must be billed on a CMS-1500 form. Please see the required
fields listed above.

As a facility, how do I bill nonprofessional services?
Facility services may be billed electronically using the HIPAA-compliant 837I format. If billing on
paper, inpatient services and alternate levels of care (e.g., PHP and IOP) must be billed on a CMS1450 form (also known as UB-04).
UB-04/CMS 1450 required fields:
o
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Service Address
Pay-to-Name and Address
Billing NPI
Provider name, address and telephone number
Type of bill
Federal tax number
Statement covers period “From” and “Through”
Patient’s name (last, first name, middle initial)
Patient’s address
Birth date
Sex
Marital status
Admission date
Admission hour
Source of referral for admission
Discharge hour
Patient status
Responsible party name and address
Revenue code
HCPCS code (if applicable)
Service date
Service units
Total charges
Payer
Release of information certification indicator
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
Assignment of Benefits
Insured’s name (last, first name, middle initial)
Patient’s relationship to insured
Certificate No. – Social Security Number – Health Insurance Claim Identification Number
Group name
 Diagnosis and Procedure Code Qualifier(ICD Version Indicator)
 Other Diagnosis Codes / Present on Admission Indicator (POA)
 Attending Provider Names and NPI
Principal diagnosis code
Admitting diagnosis code
Attending physician identification number
Provider representative
Date
How soon will I receive a claims payment?
If provider submits a clean claim electronically within timely filing limits, compensation to the
provider shall be at the rates specified in the reimbursement schedule and paid to the provider
within 30 days.

What are Payformance and PaySpan Health?
Payformance is a vendor that partners with ValueOptions to deliver an electronic funds transfer
(EFT) solution to our providers.
PaySpan Health is the software used for online registration for EFT. PaySpan Health is a multipayer adjudicated claims settlement service that delivers electronic payments and electronic
remittance advices based on your provider preferences. With PaySpan Health, you stay in control
of bank accounts, file formats, and accounting processes.

What is the unique registration code number that PaySpan Health requests and how do I obtain
it?
Your unique registration code is the registration number that ValueOptions supplies to providers for
enrolling in PaySpan Health. If you do not have the letter with your unique registration code, please
send an e-mail to CorporateFinance@valueoptions.com and include the following information:
o
o
Your ValueOptions pay-to-vendor number (PIN)
Your Tax Identification Number (TIN) or your Social Security Number (SSN)
You will receive an e-mail with your registration code letter within three business days of your
request.
Note: If you recently received a payment from ValueOptions, your unique registration code will be
located on the check stub after the marketing caption.
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For additional information on PaySpan Health, please visit:
www.valueoptions.com/providers/Files/pdfs/PaySpan_General_Training_Information.pdf
Clinical, Authorization and Quality Services Provided by ValueOptions

What are the hours of the ValueOptions Clinical Department?
Licensed clinicians are available 24-hours a day, 7 days a week, and 365 days a year. It is
imperative that, in the event of emergent care, the provider contact ValueOptions as soon as
possible, but no later than 24-hours after the emergent contact/session/admission.

As an inpatient provider, when should I request an authorization of an admission?
Pre-certification is required for all non-emergent services. After completing the evaluation, you
should call ValueOptions at (855) 627-0390 to review the clinical information and available services
or visit the ValueOptions website at www.valueoptions.com to request authorization through the
ProviderConnect portal, 24 hours a day, 7 days a week and 365 days a year.
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