Billing Manual for Community Care Network Providers

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Community Care Behavioral Health OrganizationAttn: Claims Corrections112 Washington PlaceOne Chatham Center, Suite 700Pittsburgh, PA 15219EDIPayor Name – Community Care BHOPayor ID - # 23282Community Care strongly urges providers who submit via a Clearinghouse confirmreceipt of their 997 report. Within three to five days after confirming receipt of the 997report, providers can review claim status via Provider Online.Unless Provider Online lists a check number and a check date, the claim has notbeen finalized. Please do not call the Provider Line to request payment or denialinformation unless a check number and check date is populated.Paper ClaimsMailing Address:Community Care Behavioral Health OrganizationP.O. Box 2972Pittsburgh, PA 15230Receipt of paper claim submissions can be verified 14 days after submission byaccessing Provider Online.Community Care strongly recommends providers use Provider Online to confirmpayment or denial status.Unless Provider Online lists a check number and a check date, the claim has not beenfinalized. Please do not call the Provider Line to request payment or denial informationunless a check number and check date is populated.Claim Buzz Words and PhrasesAct 62: Autism Insurance Law, PA Act 62 of 2008Adjudicate: When a claim is processed and the result is ‘posted/paid’, the claim hasadjudicated. It is the final step for that particular claim. If a corrected claim is presented,the corrected claim will have a new ‘posted/paid’ date.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 118
Authorization Rules: The definition and parameters of the service as listed on theCommunity Care Fee Schedule. (If the authorization rules have not been followed, theclaim will deny).COB: Coordination of BenefitsCommunity Care HealthChoices Member: A person receiving Medical Assistancethrough a county serviced by Community Care. The person who received treatment andwas named on the claim submitted to Community Care.Community Care Member Number: The Member’s 10-digit Recipient Number issuedby Medical Assistance.Community Care Provider: This is you, as a contracted private practitioner, agency,facility, or hospital.Consecutive Billing Days: A continuous run of days in which the same procedurecode was rendered to the same member by the same Community Care Behavioralprovider (does not have to be by the same clinician within your agency).Date of Service (DOS): The date the service was rendered.EDI: Electronic Data Interchange; the computer software system used to encode andtransmit claims data electronically.EFT: Electronic Fund TransferEVS: Eligibility Verification System - Used by providers to verify member’sHealthChoices or Medicaid eligibility.Federal Tax ID Number: The number used to identify your agency on your FederalIncome Tax returns.Form Number/Claim Number: The claim system generated eight digit number whichappears on the Community Care Remittance Advice and the Provider Online claimdetail screen. Providers are required to include this number when completing all claimcorrections.MA Provider ID Number: The 13-digit number assigned by the Commonwealth.Member Eligibility: Member is covered for behavioral health by Community Care onthe date of service. Eligibility can be verified through EVS by using a card swipemachine or calling 1-800-766-5387. If the Member is ineligible, your claim will deny,even if services were authorized.NPI Number: National Provider Identification Number (mandatory as of May 23, 2008).Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 119
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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
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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 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 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 116 and 117: Many of the services covered by Com
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 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
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
Page 162 and 163: If minor consents to treatment or c
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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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