Billing Manual for Community Care Network Providers

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Timely File requests are to be mailed to the address listed below:Community Care Behavioral Health OrganizationProvider Reimbursement Department – Timely File112 Washington PlaceOne Chatham Center, Suite 700Pittsburgh, PA 15219Attention: Place the Name of the Respective Project CoordinatorCommunity Care will present the timely file appeal requests to the applicable oversightgroup for approval.Submitting Primary Claim FormsDepending on the type of service that you are providing, you must bill Community Carethrough Electronic Data Interchange (EDI), via a claims clearinghouse, throughCommunity Care’s web-based application, Provider Online, or on paper utilizing theapplicable claim form (UB-04 or CMS-1500).Providers of inpatient services and accredited RTFs will submit claims via one of thefollowing methods:EDI claims-837 Institutional fileProvider Online-UB screensPaper Claims-UB-04Individual practitioners or other providers providing outpatient services (ambulatory,non-hospital residential, and non-accredited RTF) will submit claims via one of thefollowing methods:EDI claims-837 Professional fileProvider Online-HFCA screensPaper Claims-CMS-1500Providers should mail original paper claims to:Community Care Behavioral Health OrganizationP.O. Box 2972Pittsburgh, PA 15230EDI Claims Processing InformationClaims Clearinghouse Submissions:Payor Name – Community Care BHOPayor ID - # 23282Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 102
Providers have two options to submit claims electronically. The first of which is forclaims to be submitted via a claims clearinghouse. Providers using this method mustexecute a contract with one of the clearinghouses listed below. The clearinghouseslisted below are those with which we currently have working relationships. Beyond thesethree clearinghouses, we are certainly willing to work with any other clearinghouse thatmay express interest in doing so.Relay Health (McKesson)EMDEON (WebMD)Xactimed/MedAssetsEDI (Claims Clearinghouse) RequirementsThe EDI process for submitting claims to Community Care is the same as whensubmitting claims to other insurance carriers via EDI. The EDI specific fields will varydepending on the EDI software with which your billing system operates. However, therequired fields for EDI claims submissions to Community Care through a claimsclearinghouse are: Community Care’s Payor ID “23282” NPI number Member’s Medicaid identification number Payer’s name “Community Care BHO” Member demographics Provider demographics Claim detailCommunity Care’s Web Based Application, Provider OnlineThe second method for claims to be submitted electronically is the utilization ofCommunity Care’s web based application, Provider Online. Providers are required tocomplete a non-disclosure agreement prior to receiving any access to the ProviderOnline website. Providers must use Microsoft Internet Explorer 6.1 or greater whenutilizing the Provider Online website.For further instructions visit: http://www.ccbh.com/Providers/SecureSites/Claims.phpProvider Online enables providers to:Check the status of a claim online.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 103
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APPENDIX A.2. Confidentiality 130AP
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Clinical Fax by County:Adams 1-866-
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Outpatient Therapy 1MD OutpatientMe
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Functional Familytherapy (FFT)Multi
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Non-Acute PartialHospitalizationNot
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I.A. Code of EthicsCommunity Care
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esources and evaluated on their pro
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Confidentiality policies including
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Within 30 minutes for urban areas.W
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I.E. Care Management Team“Advocat
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In order to serve special populatio
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Psychiatric Rehabilitation Clubhous
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always be considered in light of th
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Tell their provider everything they
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and calls received on the programs
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II.D.1e EvaluationIndividuals parti
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II.D.2b GoalsThe goals of Community
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II.D.3 Providers’ Role in the Pre
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Community Care has a total of 30 ca
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Department of Health and provide in
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An explanation of the grievance pro
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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
Page 62 and 63: Accreditation of Healthcare Organiz
Page 64 and 65: III.B.4 Facility ReassessmentFacili
Page 66 and 67: present relevant information, and t
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Page 70 and 71: the implementation and application
Page 72 and 73: III.C.4 Ability to Give Informed Au
Page 74 and 75: When such disclosure to health care
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Page 80 and 81: III.E. Clinical Practice Guidelines
Page 82 and 83: Community Care has developed a plan
Page 84 and 85: eing served and uses strategies to
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Page 88 and 89: For any questions about providing s
Page 90 and 91: If you, as a Community Care provide
Page 92 and 93: When the precertification is for se
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Page 96 and 97: IV.E.3 Transition of Care to anothe
Page 98 and 99: Billing ManualCommunity Care Behavi
Page 100 and 101: Even though an authorization may be
Page 104 and 105: Provide an alternative to the use o
Page 106 and 107: Required Claim FieldsIn the followi
Page 108 and 109: 24C EMG Not required24D Procedure C
Page 110 and 111: 17 Discharge Status Required forINP
Page 112 and 113: 67a-q Diag. Code Required68 Unlabel
Page 114 and 115: • Explanation of Benefits (EOB) i
Page 116 and 117: Many of the services covered by Com
Page 118 and 119: Community Care Behavioral Health Or
Page 120 and 121: Community Care Procedure Code: The
Page 122 and 123: C/FST: Consumer/Family Satisfaction
Page 124 and 125: Medicaid/Medical Assistance identif
Page 126 and 127: APPENDICESAPPENDIX A.1. Fraud, Wast
Page 128 and 129: . The provider will also receive a
Page 130 and 131: APPENDIX A.2. ConfidentialityPOLICY
Page 132 and 133: A Facility or group practice name,
Page 134 and 135: Confidential data and information s
Page 136 and 137: The medical director or his/her des
Page 138 and 139: The privacy officer will review the
Page 140 and 141: collection and use of member identi
Page 142 and 143: Protection of information disclosed
Page 144 and 145: If a member is granted access to re
Page 146 and 147: Under some circumstances, it may be
Page 148 and 149: 164.504(e)(ii)(A)).They will take a
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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
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APPENDIX E.1. Companion Guide for N
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Billing Manual for Community Care Network Providers

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