CH 1: Introduction

This Chapter Includes:

1. About Valley Health Plan (VHP) 2. VHP’s Vision, Mission, Goal, & Value 3. What is in this Provider Manual

4. Non-Discrimination Notice

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Alert

Alert draws attention to critical information that has changed this year.

Contact

Contact information on who to contact for assistance.

Book Table of Contents

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Welcome!

Welcome to Valley Health Plan (VHP). We value the contributions you make to assist us in improving the health and well-being of the communities and members we serve. VHP’s priority is to promote healthy lifestyles through preventive health care. VHP works to accomplish this goal by partnering with you, the providers, who oversee the health care of VHP’s members.

About Valley Health Plan (VHP)

Valley Health Plan is a health care service plan licensed under the Knox-Keene Heath Care Service Plan Act of 1975 by the Department of Managed Health Care (DMHC) and is dedicated to serving the populations of Santa Clara and portions of Monterey and San Benito Counties. Operating since 1985, VHP manages the care of Medi-Cal members, as well as those members enrolled in commercial products, such as Employer Group (Classic and Preferred), Covered California and Individual & Family Plan (IFP). VHP currently serves approximately 176,000 members. VHP is accredited by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) which demonstrates our commitment to quality health care. AAAHC is a private, non-profit organization formed in 1979 to assist ambulatory health care organizations to improve the quality of care.

VHP’s ability to provide quality service is a result of leadership guided by our Vision, Mission, Values and Goal.

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Our Vision

VHP will have a positive impact on the health of our families, friends, and neighbors.

Our Mission

To support the well-being of our members through a commitment to accessible, high-quality health services and community-focused, local care. We are committed to transforming the health of the community, one person at a time. Our mission is to provide better health outcomes at lower costs. We are driven by the following beliefs: • We believe in treating the whole person, not just the physical body. • We believe that treating people with kindness, respect and dignity empowers healthy decisions. • We believe we have a responsibility to remove barriers and make it simple to get well, stay well and be well. • We believe local partnerships enable meaningful, accessible healthcare. • We believe healthier individuals create more vibrant families and communities.

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Back to Chapter 1 Table of Contents

VHP strives to improve health status, foster successful outcomes, and attain high member and provider satisfaction. VHP’s service model has been designed to achieve the following goals: • Ensure access to primary and preventive care services • Support care delivery in the best setting to achieve an optimal outcome Improve access to all necessary health care services Encourage quality, continuity, and appropriateness of medical and behavioral care; and Provide coverage in a cost-effective manner.

Our Goal

VHP’s goal is to provide members access to high-quality care, to assure member satisfaction, to continually improve the partnership with our providers, to comply with all regulatory standards and to manage financial resources responsibly.

All of our programs, operating practices and policies and procedures are designed with our vision, mission, values, and goal in mind. We are happy to have you as part of our network and thank you for assisting us in achieving our mission.

Our Values

We… • care about the total well-being of our members. • show compassion and understanding for where each person is on their health journey. • enhance our community by advocating for the diversity of individuals. • embrace a commitment to ensuring that our members are treated with dignity and respect. • form a lasting connection with our providers, brokers, and other partners to promote local business. • strive for continuous improvement in the services we offer and satisfaction with the VHP experience.

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What is in this Provider Manual

VHP is committed to providing comprehensive information to providers about VHP’s operations, programs and policies and procedures.

The information contained in this Provider Manual is relevant for individual providers, hospitals, physician groups, federally qualified health centers, medical groups, independent practice associations and their affiliated provider groups. All contracted, network providers serving the Employer Group (Classic and Preferred), Covered California and Individual & Family Plan are defined as a “provider” throughout this Provider Manual. As a contracted network provider you are responsible for adhering to the applicable requirements set forth in the Participating Provider Agreement, the member’s Evidence of Coverage and the Provider Manual.

The Provider Manual is intended for use by VHP’s contracted, network providers serving Employer Group (Classic and Preferred), Covered California and Individual & Family Plan.

This Provider Manual contains policies, procedures, and guidelines for VHP’s products by line of business (LOB):

Employer Group: Open to contracted employer groups for their employees who live or work in Santa Clara County.

Covered California: Open to residents living in Santa Clara County through the California Health Benefit Exchange.

Individual & Family Plan: Mirrored product to Covered California purchased directly through VHP for residents living in Santa Clara and portions of San Benito and Monterey Counties.

VHP has organized the Provider Manual to highlight subjects of greatest interest to providers, including, for example: Authorization and Referral Guidelines Claims and Billing Guidelines Eligibility Verification and Enrollment Pharmacy and Prescriber Information Services Covered or Administered by VHP Services Covered by Other Agencies

The Provider Manual is reviewed and revised on an annual basis or more frequently as needed. Providers will be notified when an updated version is effective. You can access the Provider Manual at www.valleyhealthplan.org or request a hard copy version by contacting VHP’s Provider Relations Department at 1.408.885.2221.

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Non-Discrimination Notice

VHP complies with all applicable federal and state civil rights laws and does not discriminate on the basis of race, color, national origin, age, religion, sex, sexual orientation, gender expression, disability, or immigration status. VHP does not exclude people or treat them differently because of race, color, national origin, age, disability or sex, religion, sexual orientation, gender expression, or immigration status.

VHP provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats, other formats). Additionally, VHP provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

If a member needs these services, please have them contact VHP’s Member Services Center at: 1.888.421.8444 (For TTY, contact California Relay by dialing 711 or 1.800.735.2929). If a member believes that VHP has failed to provide these services or has been the subject of discriminated on the basis of race, color, national origin, age, religion, sex, sexual orientation, gender expression disability, or immigration status they can file a grievance by calling the number above and asking for help filing a grievance.

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