Billing Manual for Community Care Network Providers

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A Facility or group practice name, status as a participant in Community Care’snetwork, business address, business telephone number, and services offered arenot considered confidential when disclosed for legitimate business purposes.Community Care’s business data and information considered confidential includes but isnot limited to: Salaries. Policies and procedures. Finances. Business plans. Practitioner, practitioner group, and facility participants in Community Care’s networkwhen such information is not being released for legitimate business purposes. Proposals to potential or current customers. Information disclosed to Community Care in confidence by a third party. Information including quality assurance, quality improvement and performanceevaluation data and information where practitioners, practitioner groups, or facilitiesare not individually identifiable.Community Care has an array of security provisions to protect confidential data andinformation, including: Differential access based on job responsibilities to information maintained inCommunity Care’s information system. Physical lock and key arrangements. Electronic security systems. Mandatory compliance with Community Care’s Statement of Confidentiality.The following provisions are in effect for all Community Care representatives: Divulging computer passwords and security system pass codes is prohibited. Building access codes and keys may not be shared with any individual who does nothave the right to such access codes or keys. All computers that have the ability to access confidential data or information mustbe:• Protected with a confidential log-in password.• Turned or logged off at the end of the workday.• Protected with a confidential screen-saver password in the event that thecomputer is turned on and logged on while the computer user is away from his orher work area.Community Care’s agents, contractors, employees, staff, and volunteers may notaccess or view confidential data or information unless required by his/her duties orresponsibilities for, or on behalf of, Community Care. The “Statement of Confidentiality”includes a statement that an employee has access to sensitive and confidentialinformation and by signing this statement he/she agrees not to access information fromany source(s) that is not needed to perform his/her job duties.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 132
Another part of the “Statement of Confidentiality” is that only the minimum necessaryinformation is used by any employee at Community Care to perform his/her job duties.Community Care’s expectations are that only the minimum amount of informationneeded by our employees is used.Community Care’s Compliance and IS Departments oversee and monitor employeeaccess to member confidential data. Community Care’s agents, contractors, employees,staff, and volunteers may not discuss confidential data and information in an area whereindividuals, including other Community Care agents, contractors, employees, staff, andvolunteers who do not have the right to know about the information, may overhear theinformation.All confidential data and information must be maintained in a manner that preventsaccess by individuals who do not have a right to access the data and information.All physical media, including but not limited to paper, magnetic, and optical, used tostore confidential data and information must be stored under a double lock system.All physical media containing confidential information that are still in use byCommunity Care agents, contractors, employees, staff, and volunteers at the end ofthe day must be locked in that individual’s desk or in another secured storage area.All desks or secured storage areas must be in areas with keyed entry, maintaining aminimum of a dual-key system.All physical media containing confidential information that are no longer needed byCommunity Care agents, contractors, employees, staff, and volunteers must bereturned to locked master storage at the end of the day.All electronic media containing confidential information must be password protected.The transfer of confidential information for legitimate business purposes betweenCommunity Care’s agents, contractors, employees, staff, and volunteers in their officialcapacities as representatives of Community Care, is considered an internal transfer,even though they may be in different physical locations. The data they receive may bedecoded or “aggregate data” to protect the member’s health information.The internal transfer of all confidential data and information must be conducted in amanner that limits potential access by individuals who do not have a right to access thedata and information. Each director will determine the specific access and confidentialinformation his/her employees will need to access, in order for them to carry out his/herjob duties. (HIPAA Section 164.504(f)(2)(iii)When not hand-carried and personally delivered to the recipient, physical mediacontaining confidential data and information must be placed in a sealed envelopemarked “confidential.” Confidential data and information sent by facsimile must beara prominent confidentiality notice similar to the following: “This facsimiletransmission contains confidential and privileged information for use only by theintended recipient. Do not read, copy, or disseminate this material unless you arethe intended recipient. If you believe you have received this message in error,please notify the sender by facsimile or telephone and destroy this document.”Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 133
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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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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
Page 82 and 83: Community Care has developed a plan
Page 84 and 85: eing served and uses strategies to
Page 86 and 87: dialogue and intervention may occur
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
Page 94 and 95: ORA member expresses a readiness fo
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 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 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
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
Page 156 and 157: The member has the right to request
Page 158 and 159: Policy on Release of Information Re
Page 160 and 161: y the written authorization of the
Page 162 and 163: If minor consents to treatment or c
Page 164 and 165: Current patients or clients or the
Page 166 and 167: If the client has given written aut
Page 168 and 169: Confidentiality policies pursuant t
Page 170 and 171: “Statement of Confidentiality”
Page 172 and 173: Findings will be reported to senior
Page 174 and 175: information and by signing this sta
Page 176 and 177: Community Care has identified circu
Page 178 and 179: NameAddress (es)Zip CodeDiagnosis (
Page 180 and 181: 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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