Billing Manual for Community Care Network Providers

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PsychologicalTesting/NeuropsychologicalTestingElectroconvulsiveTherapyNon-Acute PartialHospitalizationPrecertification;FacsimileTransmittalRequest FormPrecertificationfor OutpatientonlyNotification;FacsimileTransmittalRequest FormTelephonicPrecertificationPrecertificationChild or Adolescent: Authorized by testing group,peer review.Adult: Authorized by test, peer review.Peer review.Limit of 3 hours minimum to 6 hours maximum per day.Acute PartialLimit of 3 hours minimum to 6 hours maximum per day.HospitalResidentialBased on clinical necessity.Treatment FacilityRe-evaluation required every 90 days.Behavioral Health Precertification Authorized by specific procedure; Community CareServices (BHRS) 2 planning team meetings.Rehabilitativecare manager to be invited to all interagency serviceInpatient AdmissionClozaril(Monitoring/Evaluation and SupportServices) 1PsychiatricRehabilitation; Site-Based, Mobile,ClubhousePeer SupportMulti-systemicTherapy (MST)Precertificationexempt forMedicarePrimaryAnnualRegistrationOnlyPrecertification;FacsimileTransmittalRequest FormNotification;FacsimileTransmittalRequest FormMailPacket is due one week after the ISPT meetingBased on medical necessity criteria.Requires diagnoses on all 5 Axes; no V-codesNotification of admissions and within 30 days ofdischarge for Medicare Primary.Initial: Registration must be submitted following theinitial outpatient visit; not to exceed the timely filinglimits for claims submission for the member’s productcoverage.Concurrent: Registration must be submitted prior tothe expiration of the initial annual registration period;not to exceed the timely filing limits for claimssubmission for the member’s product coverage.REFER TO THE BILLING SECTION FOR TIMELYFILING LIMITS FOR EACH HEALTHCHOICESPRODUCTBased on clinical necessity.Initial: Two months authorized at pre-certification.Continued Stay: Three months authorized atcontinued stay.Unit definition: 1 unit = 15 minutes.Members must be age 18 or older or age 22 if inSpecial Education.Maximum six months authorized for each request.Packet is due one week after the ISPT meeting.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 10
Functional Familytherapy (FFT)MultidimensionalTreatment FosterCare (MTFC )Mobile MentalHealth Treatment(MMHT)Tobacco/SmokingCessationMailMailNotification;FacsimileTransmittalRequest FormNonePacket is due one week after the ISPT meeting.Packet is due one week after the ISPT meeting.Members must be age 21 or older.Maximum 30 units per 90 day authorization time frame.Based on clinical necessity and will be reviewed every90 days.Individual and group delivery.Maximum 70 units per year, per member/provider. Themaximum unit is calculated by the total number ofcombined units (individual and/or group).1Outpatient registration (OPR): Annual registration of Member required2 Includes mental health, mental retardation, and chemical dependency servicesCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 11
Page 5 and 6: APPENDIX A.2. Confidentiality 130AP
Page 7 and 8: Clinical Fax by County:Adams 1-866-
Page 9: Outpatient Therapy 1MD OutpatientMe
Page 13 and 14: Non-Acute PartialHospitalizationNot
Page 15 and 16: I.A. Code of EthicsCommunity Care
Page 17 and 18: esources and evaluated on their pro
Page 19 and 20: Confidentiality policies including
Page 21 and 22: Within 30 minutes for urban areas.W
Page 23 and 24: I.E. Care Management Team“Advocat
Page 25 and 26: In order to serve special populatio
Page 27 and 28: Psychiatric Rehabilitation Clubhous
Page 29 and 30: always be considered in light of th
Page 31 and 32: Tell their provider everything they
Page 33 and 34: and calls received on the programs
Page 35 and 36: II.D.1e EvaluationIndividuals parti
Page 37 and 38: II.D.2b GoalsThe goals of Community
Page 39 and 40: II.D.3 Providers’ Role in the Pre
Page 41 and 42: Community Care has a total of 30 ca
Page 43 and 44: Department of Health and provide in
Page 45 and 46: An explanation of the grievance pro
Page 47 and 48: Upon request, the member will be as
Page 54 and 55: Notices must be in alternate format
Page 56 and 57: Community Care is a party to the he
Page 58 and 59: The following sections provide info
Page 60 and 61:
members, practitioners are asked to
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Accreditation of Healthcare Organiz
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III.B.4 Facility ReassessmentFacili
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present relevant information, and t
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contracting, performance evaluation
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the implementation and application
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III.C.4 Ability to Give Informed Au
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When such disclosure to health care
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Practitioners are informed of the r
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Medication(s) that have been prescr
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III.E. Clinical Practice Guidelines
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Community Care has developed a plan
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eing served and uses strategies to
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dialogue and intervention may occur
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For any questions about providing s
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If you, as a Community Care provide
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When the precertification is for se
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ORA member expresses a readiness fo
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IV.E.3 Transition of Care to anothe
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Billing ManualCommunity Care Behavi
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Even though an authorization may be
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Timely File requests are to be mail
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Provide an alternative to the use o
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Required Claim FieldsIn the followi
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24C EMG Not required24D Procedure C
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17 Discharge Status Required forINP
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67a-q Diag. Code Required68 Unlabel
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• Explanation of Benefits (EOB) i
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Many of the services covered by Com
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Community Care Behavioral Health Or
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Community Care Procedure Code: The
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C/FST: Consumer/Family Satisfaction
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Medicaid/Medical Assistance identif
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APPENDICESAPPENDIX A.1. Fraud, Wast
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. The provider will also receive a
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APPENDIX A.2. ConfidentialityPOLICY
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A Facility or group practice name,
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Confidential data and information s
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The medical director or his/her des
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The privacy officer will review the
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collection and use of member identi
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Protection of information disclosed
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If a member is granted access to re
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Under some circumstances, it may be
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164.504(e)(ii)(A)).They will take a
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must verify that the member has sig
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esults, billing records, and treatm
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equestor destroy the information, o
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The member has the right to request
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Policy on Release of Information Re
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y the written authorization of the
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If minor consents to treatment or c
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Current patients or clients or the
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If the client has given written aut
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Confidentiality policies pursuant t
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“Statement of Confidentiality”
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Findings will be reported to senior
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information and by signing this sta
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Community Care has identified circu
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NameAddress (es)Zip CodeDiagnosis (
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Community Care has the right to den
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Member identifiable information may
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Community Care extends all reasonab
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For research purposes.On behavioral
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See the policy on Transition of Pri
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Community Care does not collect inf
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The request must be in writing. Cre
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All statements to the media includi
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• The name, or title, and the tel
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APPENDIX A.4. Significant Member In
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Orientation and ongoing provider ed
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CONSENT FOR RELEASE OF INFORMATIONM
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Authorization for the Release of Dr
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___________________________________
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APPENDIX C.1. Priority PopulationsM
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Second priority is associated with
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3. Secondary Data - OMHSAS will dev
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BEHAVIORAL HEALTH MANAGED CARE ORGA
Page 216 and 217:
APPENDIX E.1. Companion Guide for N
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Billing Manual for Community Care Network Providers

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