Billing Manual for Community Care Network Providers

Medicaid/Medical Assistance identification cards to verify that the individuals are eligibleto receive HealthChoices (Medicaid, Medical Assistance) covered services.PROMISe: Provider Reimbursement and Operations Management Information System;Office of Medical Assistance Program’s information management system that producesprovider Medical Assistance enrollment numbers. The Office of Mental Health andSubstance Abuse Services and Community Care require provider enrollment throughthe Office of Medical Assistance prior to rendering behavioral health services.PsychConsult MCO ® : The computer software database program Community Careuses to record and report data to each provider and member.RC: Resource Coordination; a case management service to meet a member’s need formultiple services and supporters.Routine: Routine outpatient services, other than psychological evaluations, areidentified related to member need when a behavioral health condition requiresassessment and/or treatment but there is no apparent imminent or impending risk to themember or others and no evidence that the member has significant function impairment.RTF: Residential Treatment FacilitySF-12: Short Form Health Survey (a level of function measure)SBPH: School Based Partial HospitalizationSupplemental Services: These services may be paid for by Community Care but arenot HealthChoices in-plan services.Urgent: The onset of a mental and/or nervous or substance abuse conditionmanifesting itself by serious symptoms such that the mental health or physical wellbeingof the enrollee will deteriorate unless the enrollee is treated by the provider within24 hours, or in a case in which the enrollee believes that urgent assessment is required.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 124