Billing Manual for Community Care Network Providers

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The medical director or his/her designee will request a description of the purpose forthe requested information from the business associate.All requests for de-identified information will be recorded in the Request for DeidentifiedInformation log.Each request will be reviewed individually.For each request, Community Care will determine how this information will be deidentified.If Community Care is able to reduce the amount of information requested while stillmeeting a business associate’s request, we will do so.Community Care will develop a code to de-identify this information (HIPAA164.514(c). This code will be unique with each request for information. This code willnot be released to the business associate, and each code will be kept in the Requestfor De-identified Information Log. Only the medical director or his/her designee willhave access to this log.The medical director will present the request for information to the OutcomesCommittee for final approval.When the privacy officer receives the decision from the Outcomes Committee; theywill notify the requestor in writing, confirming if the requested information will bereleased, the manner in which it will be released, and how the information will be deidentified.If Community Care did not grant the request for information, a briefexplanation of the reason will be given instead.Once this has all occurred, the member will be contacted by Community Care to seeif he/she would like to participate in any active clinical research activity. CommunityCare is required to receive the member’s authorization prior to the release of anyinformation to a business associate for research purposes. If the member agrees toparticipate in the study and once the signed authorization is received from themember, the information will be released to the business associate conducting theresearch.If the member declines to take part of this study, his/her coverage will not beterminated with his/her refusal to participate.Collecting and Using Member Identifiable InformationCommunity Care collects and uses only the minimum necessary member identifiabledata and information routinely in the performance of our work. Community Careemployees are required to sign a “Statement of Confidentiality” when hired, agreeing tobe bound by Community Care’s strict confidentiality policies and procedures and allfederal and state laws.Community Care considers the following as member identifiable information, but it is notlimited to that listed below. This information used alone or in any combination mayidentify the member (HIPAA 164.512(b)(2)(i).NameAddress (es)Zip CodeCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 136
Diagnosis (es)Treatment DatesDate of BirthDate of DeathTelephone Number (s)Fax NumberElectronic Mail AddressSocial Security NumberUtilization Record ID NumberHealth Plan Beneficiary Number (s)Account Number (s)Certificate/License NumberDriver’s License NumberWeb Universal Resource Locators (URL’s)Any unique identifying number, characteristic, or code that Community Care createdthat if external sources deciphered the code they could identify the member.There are times when disclosures of protected health information are made on a routineand recurring basis, to providers for the purposes of treatment, payment, and healthcare operations. (HIPAA Section 164.514(d)(3)). These disclosures are a vital part ofour daily performance and may not be restricted. The provider identification is verifiedby our caller ID system as well as by the provider supplying specific identifyinginformation pertaining to the member, e.g., member ID and Social Security Numbers.Community Care staff identifies themselves to providers with their names, titles, andspecific identifying information pertaining to the member. If at any time there is aquestion as to the identity of the caller, staff members are instructed to take the name ofthe caller, the facility that is calling, and a telephone number where the call can bereturned. The contact and telephone number are verified before the call back is madeand any information is divulged.While Community Care does not maintain a medical record, Community Care doeskeep a utilization record. Per HIPAA (Section 164.501) a designated record set whichCommunity Care refers to as a utilization record is – a group of records maintained byor for Community Care, used, in whole or in part, by Community Care to make decisionsabout the member or provider, which may contain the following but is not limited to:The medical and billing records about the member or provider.The enrollment, payment, claims adjudication, and case or medical managementrecord systems maintained by Community Care.In accordance with HIPAA Section 164.524, the member may request to restrict thisinformation if desired. The member has the right to request at any time to restrict thecollection, use, or disclosure of his/her protected health information. The member maywrite a letter to the privacy officer at Community Care, requesting to restrict thedisclosure of his/her protected health information. The letter must include what specificinformation the member wants restricted, the member’s signature, and it must be dated.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 137
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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
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Community Care has developed a plan
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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
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 132 and 133: A Facility or group practice name,
Page 134 and 135: Confidential data and information s
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
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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
Page 182 and 183: Member identifiable information may
Page 184 and 185: 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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