- 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
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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
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APPENDIX E.1. Companion Guide for N