Santa Clara Valley Health _ Hospital System

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					Santa Clara Valley Health & Hospital System                                    Innovative Partnership
Department of Alcohol & Drug Services Adult System of Care                     Policy & Procedure Manual
Page 1 of 2                                                                    9/30/08
VHP Referrals                                                                  Policy & Procedure 160

POLICY               The Department of Alcohol & Drug Services (DADS) Adult System of Care has
                     a Memorandum of Understanding with Valley Health Plan (VHP) to provide
                     Alcohol and Drug treatment services for eligible VHP members and their
                     dependents. Valley Health Plan clients are given priority admission as follows:

                                •     Pregnant
                                •     HIV or other serious medical condition(s)
                                •     IV drug users
                                •     Detox and Residential transfers
                                •     Valley Health Plan Clients
                                •     Discovery Group Clients
                                •     All others, in order of date referral received

PROCEDURE

 Gateway             Valley Health Plan members are instructed to call Gateway for screening,
                     assessment, and referral into the Adult System of Care. If VHP members call
                     seeking services for their dependent children or adolescents, they should be
                     referred to Dan Lloyd in the DADS Children, Families, and Community Services
                     Division. Gateway will call VHP Member Services (408-885-4760) and verify a
                     member’s eligibility prior to screening. Upon verification, Gateway staff will
                     complete a Level of Care Assessment with the client and fax the “Gateway
                     Referral for Valley Health Plan Clients” form (see Appendix D2) to the Program
                     Manager of the VHP-designated site to which the client is being referred for
                     treatment.

 Providers           The client will contact the provider site to schedule an individual intake
                     appointment with a licensed or VHP-credentialed therapist. While scheduling
                     the intake appointment, the provider should remind the client to bring the VHP
                     Insurance Card to the intake appointment.

                     NOTE: VHP clients are not assigned to Discovery Groups nor to waitlists; they
                     must be admitted within three days of their referral by Gateway.

                     At admission, have the client complete the “Payor Financial Information and
                     Consent to Release Medical Insurance Information and Assignment of Benefits
                     Form” (see Appendix D2). When entering VHP clients into the Unicare System,
                     identify the client as a VHP client by using a “V50” at the Payor level.

                     When transferring a VHP client, fax the “Gateway Referral for Valley Health
                     Plan Clients” form to the receiving VHP-designated Provider to alert the
                     Provider that a VHP client is being transferred to their site.



                                                                                            VHP Refs.rev.9.21.08.jw
Santa Clara Valley Health & Hospital System                               Innovative Partnership
Department of Alcohol & Drug Services Adult System of Care                Policy & Procedure Manual
Page 2 of 2                                                                  9/30/08
VHP Referrals                                                                Policy & Procedure 160
 Providers            If, for any reason, a Provider needs to verify that a client is a VHP member,
 (cont’d)             contact the Member Benefits Line of Valley Health Plan at (408) 885-4760 and
                      request an eligibility check for the client. If the person answering the phone is
                      unable to assist you, contact Laura Eglesia, VHP Program Manager, at (408)
                      885-4762.

                     Providers must send a copy of the completed Payor Financial Information
                     Consent to Release Medical Insurance Information and Assignment of Benefits
                     form to:

                        Internal Address:                             External Address:
                        PBS – MH Unit                                 Ms. Rosie Ozuna
                        AOB, 4th Floor                                PBS-MH Unit
                        Attn: Rosie Ozuna                             SCVHHS
                                                                     751 S. Bascom Avenue
                                                                      San Jose, CA 95128

                        Phone: (408) 885-7341      Fax: (408) 885-7399
                        Email: Rosie.Ozuna@hhs.co.scl.ca.us


                     Important Billing Instructions:
                     On a monthly basis, SCVHHS Patient Billing Services (PBS) will bill VHP for
                     services provided. However, it is the responsibility of each Provider to enter
                     services properly into Unicare for billing purposes. The Payor Financial
                     Information (PFI) must be entered into Unicare and the completed Payor
                     Financial Information Consent to Release Medical Insurance Information and
                     Assignment of Benefits Form must be forwarded to PBS for any billing to be
                     completed.




                                                                                       VHP Refs.rev.9.21.08.jw

				
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