Billing Manual for Community Care Network Providers

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Many of the services covered by Community Care can be rendered multiple times onthe same date of service. When the same service has been rendered multiple times(same procedure code and modifier), the total number of units rendered should becombined on one line on the claim form or you can submit as separate lines on thesame claim form by place of service. However, if a claim is submitted for a serviceand then subsequent units are discovered, the subsequent units MUST be submittedas a claim correction to the original submission (3 units originally billed, an additional4 units sent to provider’s billing office – a “corrected claim” for 7 units should besubmitted to Community Care).Anytime you receive a denial for a “duplicate claim,” verify that the service is a trueduplicate and not a claim submission for subsequent units on the same day ofservice.If there is an issue with your claim related to the modifier, a “corrected claim,”reflecting the correct procedure code and modifier must be submitted to update theoriginal claim.To correct any inadvertent error in billing, submit a “corrected claim” to update theoriginal claim.To reverse a denied claim, a “corrected claim” MUST be submitted with theadditional information to update the original claim.Providers who mail paper corrected claims are required to stamp or write the words“Corrected Claim” and the form/claim number on all corrected claims, regardless ofthe claim form type. This should NOT be done in red ink within the body of the claim.Red ink interferes with the scanning process. Black ink does not.Providers who mail paper corrected claim forms are required to populate Block 22 ofthe CMS-1500 or Block 64 of the UB-04 with the original claim/form number.All claim corrections are subject to the timely file guidelines.Community Care strongly recommends all claim corrections be completedelectronically.Submitting Claim CorrectionsCommunity Care can accept claim corrections via three methods:1. EDI – Preferred method2. Provider Online3. Paper Claim CorrectionsProvider Online – Claim CorrectionsCommunity Care strongly encourages providers to complete claim corrections viaProvider Online; Community Care’s web based product. Submitting claims correctionsto Community Care via Provider Online expedites the processing of and ensures theaccuracy of completing the claim correction process. The Provider Online User Guidecan be accessed via the website below. The Provider Online User Guide is locatedunder the Reference Library. To obtain access to Provider Online, please call theProvider Line 1-888-251-2224 and follow the prompts to the Provider ReimbursementDepartment.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 116
Provider Online Website:https://online.ccbh.com/ccbhproductionPaper Claim CMS-1500 – Claim CorrectionsProvider is required to write ‘Corrected Claim’ at the top of each CMS-1500 whensubmitting a corrected claim to Community Care. Draw a line through or circle theincorrect information and write the correct information directly on the CMS-1500.Include the original claim/form number on the CMS-1500 when submitting a claimcorrection.UB-04 - Claim Corrections Type of Bill (Form Locator 4)Provider is required to write ‘Corrected Claim’ at the top of each UB-04 whensubmitting a corrected claim to Community Care.Form Locator 4-Type of Bill must represent the appropriate three digit code. Pleaserefer to the information provided below. Draw a line through or circle the incorrectinformation and write the correct information directly on the UB-04.Include the original claim/form number on the UB-04 when submitting a claimcorrection.UB-04 - Claim Corrections - Type of Bill (Form Locator 4)Applicable to Provider Online, Claims Clearinghouses & Paper ClaimsThis three digit code gives three specific pieces of information. First Digit – identifies the type of facility Second Digit – classifies the type of care Third Digit – indicates the sequence of this bill in this particular episode of careFirst Digit 1 - Type of Facility – HospitalSecond Digit 1 - Bill Classification – InpatientThird Digit 1 - Admit through Discharge Claim 2 - Interim – First Claim 3 - Subsequent Interim Claims 4 - Last Interim Claim 7 - Replacement of a Prior Claim 8 – Claim VoidsMail Paper Claim Corrections To:Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 117
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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
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Notices must be in alternate format
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Community Care is a party to the he
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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
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
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Page 88 and 89: For any questions about providing s
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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 102 and 103: Timely File requests are to be mail
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 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
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Page 144 and 145: If a member is granted access to re
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Page 148 and 149: 164.504(e)(ii)(A)).They will take a
Page 150 and 151: must verify that the member has sig
Page 152 and 153: esults, billing records, and treatm
Page 154 and 155: equestor destroy the information, o
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Page 160 and 161: y the written authorization of 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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