Psychiatrists
Additctionologist (non-Psychiatrist)
Psychologists
Social Workers
Psychiatric Nurses/Clinical Specialists (RNCS)
Professional Counselors
Pastoral Counselors
Criteria for Specialty Networks Voluntary Participation

The following criteria applies to all practitioners serving the Commercial network:

Accessible twenty-four (24) hours a day, seven (7) days a week, and agree to make appointments available within the following guidelines:

Emergencies - The member must be offered the opportunity to be seen immediately.

Serious Risk (Urgent) - In an urgent situation, a member must be offered the opportunity to be seen within 24 hours of the call for an appointment

Mild/Moderate Risk (Routine) - In a routine situation, a member must be offered the opportunity to be seen within 7 calendar days of a call for an appointment.

Please see Provider Handbook, Section C - Participating Provider Responsibilities for details – (www.valueoptions.com)

The following criteria applies to all practitioners serving the OPTIONS / TRICARE network:

Accessible twenty-four (24) hours a day, seven (7) days a week, and agree to make appointments available within the following guidelines:

Emergency Appointments - emergency seen immediately

Urgent Appointments - within 24 hours of the request

Routine Appointments - within three (3) calendar days of the request

Must possess a Doctor or Medicine (MD) degree or Doctor of Osteopathy (DO) degree from an accredited medical school.

Board certified in psychiatry as defined by the American Board of Psychiatry and Neurology OR Certified by the American Society of Addiction Medicine (ASAM) or the American Board of Psychiatry and Neurology in Addiction Medicine OR Graduated from an accredited residency program.

Licensed to practice medicine in the state where practice is to occur.

Must possess a current Drug Enforcement Administration (DEA) Certificate.

Completed a training program approved by American Council of Graduate Medical Education (ACGME) or Osteopathic- approved residency training program in psychiatry.

State Controlled Substance Registration Certificate (where applicable)

Graduates of foreign medical schools must submit an Educational Commission for Foreign Medical Graduates (ECFMG) Certificate.

All eligible providers must have a minimum of three (3) years residency experience in a mental health/substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Primary admitting privileges or designate an in network physician or facility.

Board certified in psychiatry as defined by the American Board of Psychiatry and Neurology. Child psychiatrist must have completed a general psychiatry residency that includes two years of training in an Accreditation Council for Graduate Medical Education (ACGME) – accredited child and adolescent psychiatry program OR

Board-eligible in psychiatry, with two (2) references (use form attached) attesting to your clinical competence from board-certified psychiatrists with medical staff appointment and delineated privileges at a Joint Commission on accreditation of Healthcare Organizations (JCAHO) or a Committee for the Accreditation of Rehabilitation Facilities (CARF) accredited institution. These reference letters must be sent directly to OPTIONS from the psychiatrists providing the reference, not submitted through the requesting provider

Current medical staff appointment and delineated privileges at either a JCAHO or CARF accredited facility or designate an in network physician or facility

All eligible non-board certified providers must have a minimum of three- (3) years post residency experience in a mental health/substance abuse setting providing direct patient care.

TRICARE- certified provider through Palmetto Government Benefits Administrators (PGBA)

Must possess a Doctor or Medicine (MD) degree or Doctor of Osteopathy (DO) degree from an accredited medical school.

Certified by the American Society of Addiction Medicine (ASAM) as an addictions specialist.

Licensed to practice medicine in the state where practice is to occur.

Must possess a current Drug Enforcement Administration (DEA) Certificate.

State Controlled Substance Registration Certificate (where applicable)

Graduates of foreign medical schools must submit an Educational Commission for Foreign Medical Graduates (ECFMG) Certificate.

All eligible providers must have a minimum of three (3) years residency experience in a mental health/substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Primary admitting privileges or designate an in network physician or facility.

Two (2) references (use form attached) attesting to your clinical competence from board-certified psychiatrists with medical staff appointment and delineated privileges at a Joint Commission on accreditation of Healthcare Organizations (JCAHO) or a Committee for the Accreditation of Rehabilitation Facilities (CARF) accredited institution. These reference letters must be sent directly to OPTIONS from the psychiatrists providing the reference, not submitted through the requesting provider

Current medical staff appointment and delineated privileges at either a JCAHO or CARF accredited facility or designate an in network physician or facility

TRICARE- certified provider through Palmetto Government Benefits Administrators

Must possess Doctoral degree (PhD, EdD, PsyD) in clinical psychology or counseling psychology from an accredited college or university AND meet one of the following:

1. Doctorate was received from a college program on the American Psychological Association (APA) approved list of counseling psychology or clinical psychology programs at the time of graduation OR
2. Completion of a pre-doctoral APA approved clinical internship at the time of graduation OR
3. Listed in the National Register of Health Service Providers in Psychology OR
4. Be a diplomate with the American Board of Professional Psychology (ABPP) under the clinical psychology or counseling psychology categories.

Note: A respecialization in clinical psychology or counseling psychology is eligible with proof of completion of training.

Licensed independently as a clinical psychologist at the highest level in the state where practice is to occur.

All eligible providers must have a minimum of three (3) years post-licensure clinical experience in the direct provision of mental health and/or substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Evidence of current competence in performance, clinical judgement, and clinical and technical skills by one reference (use attached form) from previous or current employers, clinical supervisors, peer supervisors, or colleagues in active professional practice. This reference must be sent directly to OPTIONS from the source providing the reference, not submitted through the requesting provider.

Completed two (2) years of supervised clinical experience in psychological health services, of which at least one year is post-doctoral and one year (may be the post-doctoral year) is in an organized psychology service training program, OR

Listed in the National Register of Health Service Providers in Psychology, published by the Council for the National Register of Health Service Providers in Psychology

Psychologists who admit patients must have admitting privileges at a JCAHO or CARF accredited institution, and have a professional relationship with a physician who is accountable for the physical assessment of the psychologist's patients while they are hospitalized (required if applicable)

TRICARE- certified provider through Palmetto Government Benefits Administrators

Must possess Master’s degree or higher from a graduate school of social work accredited by the Council on Social Work Education (CSWE).

State licensed or certified to practice at the highest level of independent practice in the state where practice is to occur.

All eligible providers must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Licensed/Certified to practice at the highest level of independent practice in the state where services are to occur OR

In states without independent licensure/certification, practitioner must possess a current ACSW credential (through the National Association of Social Workers) or be a Diplomate of the American Board of Examiners in Clinical Social Work (copy of certificate/diploma required)

Evidence of current competence in performance, clinical judgement, and clinical and technical skills by one reference (use attached form) from previous or current employers, clinical supervisors, peer supervisors, or colleagues in active professional practice. This reference must be sent directly to OPTIONS from the source providing the reference, not submitted through the requesting provider

Have had a minimum of two (2) years and 3,000 hours of post Master's degree supervised clinical social work practice under the supervision of a licensed or certified Master's level social worker

TRICARE- certified provider through Palmetto Government Benefits Administrators

Must possess Master's degree in psychiatric nursing from an accredited college or university recognized by the National League for Nursing.

State licensed to practice as a nurse at the highest level of independent practice in the state where practice is to occur.

Certified by the American Nurses Association, American Nurses Credentialing Center (ANCC) as a Clinical Specialist.

All eligible providers must have a minimum of three (3) years post-licensure clinical experience in the direct provision of mental health and/or substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Evidence of current competence in performance, clinical judgement, and clinical and technical skills by one reference (use attached form) from previous or current employers, clinical supervisors, peer supervisors, or colleagues in active professional practice. This reference must be sent directly to OPTIONS from the source providing the reference, not submitted through the requesting provider

In states that permit nurses to prescribe medication, possess a current Drug Enforcement administration (DEA) Certificate (if applicable) AND

Possess a current state Controlled Substances Registration Certificate (where applicable)

TRICARE- certified provider through Palmetto Government Benefits Administrators

Must possess Master's degree or higher in nursing from an accredited college or university in a program recognized by the National League for Nursing.

State licensed to practice as a nurse at the highest level of independent practice in the state where practice is to occur.

Certified by the American Nurses Association, American Nurses Credentialing Center (ANCC) as a Clinical Specialist.

All eligible providers must have a minimum of three (3) years post-licensure experience in a mental health/substance abuse setting providing direct patient care.

Have a practice agreement with an in network physician (MD or DO), must submit copy of agreement, in addition complete a Supervisory Addendum Form.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $3,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts)

Must possess Master's degree or higher in a mental health discipline from a regionally accredited college or university.

State licensed or certified at the highest level of independent practice in the state where practice is to occur. Only acceptable in those states where clinical experience and exam requirements equal or exceed 2 years or 2,000 hours of clinical experience or 1,000 hours of direct clinical contact (face-to-face) under an approved supervisor as defined by the appropriate state regulatory agency. Must have received 100 hours of face-to-face supervision by an approved supervisor (as defined by the state) during the first two years of post-graduate direct clinical experience.

All eligible providers must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

In states without licensure or certification, must be a Certified Clinical Mental Health Counselor (CCMHC) as determined by the Clinical Academy of the National Board of Certified Counselors (NBCC) [proof of NBCC certification required] OR

Meet all requirements to become a CCMHC [documentation of eligibility from NBCC required]

Evidence of current competence in performance, clinical judgement, and clinical and technical skills by one reference (use attached form) from previous or current employers, clinical supervisors, peer supervisors, or colleagues in active professional practice. This reference must be sent directly to OPTIONS from the source providing the reference, not submitted through the requesting provider

TRICARE requires physician referral and supervision of mental health counselors. TRICARE requires ongoing coordination with the physician and certification of this on each claim submitted.

TRICARE- certified provider through Palmetto Government Benefits Administrators

Must possess Master's degree or higher in mental health discipline from a regionally accredited college or university.

State licensed or certified at the highest level of independent practice in the state where practice is to occur. Only acceptable in those states whose clinical experience and exam requirements equal or exceed 2 years or 2,000 hours of clinical experience or 1,000 hours of direct clinical contact (face-to-face) under an approved supervisor as defined by the appropriate state regulatory agency. Must have received 100 hours of face-to-face supervision by an approved supervisor (as defined by the state) during the first two years of post-graduate direct clinical experience.

All eligible providers must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Possess current unrestricted license or certification to practice at the highest independent level as a Marriage and Family Therapist in the state where services will occur OR

In states without licensure, certified as a full clinical member of the American Association for Marriage and Family Therapy

OR

Proof of eligibility for full clinical membership in AAMFT (documentation from AAMFT required)

Evidence of current competence in performance, clinical judgement, and clinical and technical skills by one reference (use attached form) from previous or current employers, clinical supervisors, peer supervisors, or colleagues in active professional practice. This reference must be sent directly to OPTIONS from the source providing the reference, not submitted through the requesting provider

TRICARE requires physician referral and supervision of mental health counselors. TRICARE requires ongoing coordination with the physician and certification of this on each claim submitted.

TRICARE- certified provider through Palmetto Government Benefits Administrators

Must possess Master’s degree or higher in mental health discipline from a regionally accredited college or university.

Must be licensed in one of the disciplines recognized by ValueOptions (MD/DO, PSY, SW, RNCS, ARNP, MFT, OR LPC) at the highest level of independent practice in the state and meet the ValueOptions credentialing criteria where the practice is to occur. OR Must be licensed or certified as a Pastoral Counselor in Maine, New Hampshire, North Carolina, Idaho, Indiana, or Tennessee.

Must be credentialed as a Diplomate or Fellow with the American Association of Pastoral Counselors (AAPC) with a minimum of 3 years clinical experience.

All eligible providers must have a minimum of three (3) years post-licensure clinical experience in a mental health/substance abuse setting providing direct patient care.

Possess professional liability coverage at a minimum level of $1,000,000 per episode and $1,000,000 aggregate. Exceptions will be made in states where the maximum amount of coverage obtainable is less than the limits above. Copy of current face sheet must be included (must indicate applicant as the insured, policy period and coverage amounts).

Must possess current unrestricted license or certification to practice as a pastoral counselor in the state where services are to occur OR

In states without licensure, be a fellow or diplomate member of the American association of Pastoral Counselors (AAPC) OR

Meet all requirements to become a fellow or diplomate member of the AAPC [documentation of eligibility from AAPC required]

Possess a minimum of an earned Master’s degree from a regionally accredited educational institution in an appropriate behavioral science mental health discipline

Have completed 200 hours of approved supervision in the practice of pastoral counseling, ordinarily to be completed in a 2 to 3 year period, of which at least 100 hours must be under individual supervision (this supervision shall occur preferably with more than one supervision and should include a continuous process of supervision with at least three (3) cases, and 1,000 hours of clinical experience in the practice of pastoral counseling under approved supervision, involving at least 50 different cases OR

Have completed 150 hours of approved supervision in the practice of psychotherapy, ordinarily to be completed in a 2 to 3 year period, of which at least 50 hours must be under individual supervision, and at least 50 hours of approved individual supervision in the practice of pastoral counseling, ordinarily to be completed within a period of not less than one (1) nor more than two (2) years, and 750 hours of clinical experience in the practice of psychotherapy under approved supervision involving at least 30 different cases, and at least 250 hours of clinical practice in pastoral counseling under approved supervision involving at least 20 different cases

Evidence of current competence in performance, clinical judgement, and clinical and technical skills by one reference (use attached form) from previous or current employers, clinical supervisors, peer supervisors, or colleagues in active professional practice. This reference must be sent directly to OPTIONS from the source providing the reference, not submitted through the requesting provider

TRICARE requires physician referral and supervision of pastoral counselors. TRICARE requires ongoing coordination with the physician and certification of this on each claim submitted.

TRICARE- certified provider through Palmetto Government Benefits Administrators

In addition to meeting the requirements above, EAP Counselors must hold active status as a Certified Employee Assistance Professional (CEAP) or the Practitioner must have verifiable experience in the provision of EAP service delivery which includes a minimum of 3 years experience in the community where practicing and 2 years of experience as an internal EAP counselor and/or as an external EAP consultant to other work organizations. Examples of verifiable experience include but are not limited to:

• Management consultation
• Direct care
• Administrative functions of an EAP practice
• Site manager
• Crisis intervention
• Drug and alcohol treatment

Must have completed a state-level certification acceptable to support eligibility for the National Certified Addiction Counselor (NCAC) credential or International Certified Alcohol and Drug Counselor Certification (ICADC). A copy of this certificate must be provided with the application. Or, the practitioner must demonstrate an acceptable level of training and/or experience in the assessment and/or treatment of chemical dependency.

ValueOptions, Inc may modify these requirements based on regional factor.

Must possess state level certification acceptable eligibility for the National Certified Addiction Counselor (NCAC) credential or International Certified Alcohol and Drug Counselor Certification (ICADC). Please include current copy.

Accessible twenty-four (24) hours a day, seven (7) days a week, and agree to make appointments available within the following guidelines:

Emergencies and Urgent - All EAP affiliates may be asked to handle emergency and urgent appointments. These emergency and urgent assessments should be conducted on an immediate basis and ValueOptions will coordinate them at the time the referral is made.

Routine Appointments - Routine Appointments should be offered to EAP participants within three (3) business days of the initial referral date.

Please see Provider Handbook, Section A – Getting Started for details – (www.valueoptions.com)

Must meet ValueOptions commercial credentialing criteria in force for either psychiatrist or psychologist at the time of application.

Must be able to accept a referral from a ValueOptions Care Manager within 4 hours and schedule a face-to-face evaluation of the patient within 72 hours of contact with the ValueOptions Care Manager.

Must have two years of experience performing disability evaluations.

Must have an understanding and appreciation of how work place issues impact clinical presentations involving psychiatric disability claims.

Must be willing to collect information from collateral sources in order to assess pre-impairment functioning.

Must be able to assign impairment and/or disability ratings.

Psychologist must be able to administer, score, and interpret a psychological test battery that evaluates current status, enables prognostic statements, and has the potential to detect malingering.

Must meet the ValueOptions commercial criteria in force for either psychiatrist, psychologist, social worker, psychiatric nurse, Marriage and family therapist, or licensed professional counselor at the time of application.

Must have 2 years of experience providing psychotherapeutic services to people with psychiatric disabilities.

Must have demonstrated experience in the treatment and management of cases involving psychotic disabilities.

Must be able to communicate with ValueOptions disability care managers on an ongoing and consistent basis.

Must meet the ValueOptions commercial criteria in force for either psychiatrist (MD/DO) or psychologist (PhD, PsyD, EdD) or Addictionist at the time of application.

Must be a member in the American Academy of Psychiatry and Law or American Board of Professional Psychologists (ABPP) or hold valid certification by the American Society of Addiction Medicine (ASAM) or holds National Certified Addiction Counselor (NCAC) or International Certified Alcohol and Drug Counselor Certification (ICADC).

Must be able to schedule an appointment within 24 hours of your acceptance of referral from a ValueOptions Care Manager.

Must be willing to function as part of a team assigned to one or more specific locations and

Must be able to perform a face-to-face evaluation within 24 hours if requested, provide feedback immediately (if requested with the exception of psychological testing results), and complete and return an FFD form within 3 business days and

Must be able to schedule within 72 hours in cases where psychological testing is to occur. Report must be completed and returned within 3 business days after the completion of the testing.

Must be willing to engage in on-going dialogue with ValueOptions care managers on an as-needed basis.

Must be willing to testify in legal/court proceedings when requested.

Please Note: Practitioners have the right to review information submitted in support of their credentialing application. All requests for documentation must be submitted in writing. ValueOptions will not release information obtained through the primary source verification process, when disclosure is prohibited by law.