Information for Providers
PMHS Systems Overview
The Mental Hygiene Administration (MHA) is the agency within the Department of Health and Mental Hygiene responsible for the delivery of public mental health services. MHA operates five inpatient psychiatric facilities and two residential treatment centers for children and adolescents, and funds community mental health services for Medicaid eligible individuals. In addition, MHA funds services to individuals who, because of the severity of their illness and their financial need, are qualified to receive state subsidized services. For the most part, these services are provided and funded through a fee-for-service system.
In the community setting, MHA funds community mental health services for individuals who are eligible for Medicaid. Services are also provided to those, who because of the severity of their illness and their financial need, qualify to receive state-subsidized services.
These services are provided by 19 Core Service Agencies (CSA) located across Maryland. The CSAs contract for services that include peer support programs, training and others not reimbursed through the fee-for-service system.
MHA and the Core Service Agencies are assisted in their responsibility to manage the Public Mental Health Services by an administrative service organization (ASO), which operates under a contract with MHA. The ASO, ValueOptions, authorizes services, provides utilization management, management information, claims processing, and evaluation services.
The ASO provides the following services:
- 24-hour access for clinically related calls
- Referring individuals to qualified service providers
- Preauthorization of non-emergency care
- Review of Authorization Plans to assist in determining whether an individual meets Medical Necessity Criteria and is part of the Public Mental Health System
- Conducting utilization reviews of services
- Collecting data
- Processing claims
- Remitting payments
- Assisting with the evaluation of the PMHS
Any practitioner who is authorized under the Health Occupations Article according to Maryland state law (COMAR) to provide mental health services, or a provider who is licensed under the Maryland Department of Health and Mental Hygiene Regulations, may be a provider in the PMHS.
Providers can access information regarding participation in the Public Mental Health System (PMHS) at http://dhmh.maryland.gov/mma/providerinfo/
Community Mental Health Program Application
How to become a provider
Procedures for Service Delivery,Authorization and Payment
Public Mental Health System (PMHS) “Applicant Interest Meeting”
ValueOptions does not credential or contract directly with PMHS providers. Providers are credentialed and contracted by the DHMH. The provider information in the DMHM system (MMISII) is downloaded to ValueOptions weekly.
Click Here to go to ValueOptions® Website
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 PMHS can be accessed at:
The MA number must be a valid provider type and status. See Appendix M, State Approved Medicaid Provider Types for the PMHS.
The provider should also contact ValueOptions® Customer Service, 1-800-888-1965, option 3, to request a “Welcome Packet.” The Packet contains important information about ValueOptions®, including authorization and claims payment processes, as well as instructions for enrolling in the on-line authorization system, ProviderConnect®.
This information can also be downloaded at: http://maryland.valueoptions.com/providers.htm
The “Provider Confidentiality Agreement” included in the packet must be signed and returned before access to ValueOptions will be granted.
Resources for provider