Billing Manual for Community Care Network Providers

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164.504(e)(ii)(A)).They will take appropriate precautions with the information they are given (HIPAASection 164.504(e)(ii)(B)).In the event that someone discloses information they will report the breach toCommunity Care as soon as they become aware of it (HIPAA Section164.504(e)(ii)(C)).They will ensure any additional agents, including subcontractors, to whom thisinformation may become available to, follow the same restriction and conditions thatapply to them (HIPAA Section 164.504(e)(ii)(D)).The member may access, amend, or have an accounting of the information that isreleased to a business associates.The information released by Community Care will be available if requested by theSecretary of Health and Human Services in order to track Community Care’scompliance with HIPAA (HIPAA Section 164.504(e)(ii)(H)).At the termination of the contract or when this information is no longer needed, thebusiness associate has the necessary means to destroy this information or have thisinformation returned to Community Care in order for it to be destroyed (HIPAASection 164.504(e)(ii)(I)).A business associate’s contract may be terminated at any time if we feel thebusiness associate has violated any of the above (HIPAA Section 164.504(e)(iii)).Community Care may disclose protected health information about victims of abuse,neglect, or domestic violence without an authorization to law enforcement officials orgovernment agencies by a representative using his/her professional judgment (HIPAASection 164.512(c)(1)). If Community Care releases such information, it will promptlyinform the member that such a report has been made except when:Informing the member would put them in serious danger or harm.Community Care is unable to inform the member in which case the personalrepresentative may be informed that Community Care released this information.However, if Community Care believes the personal representative is responsible forthe abuse, neglect, or other injury then he/she would not be notified.Community Care may disclose protected health information without an authorizationto a law enforcement official:When required by law for the purposes of, but not limited to, investigating acomplaint, civil, or criminal charges. (HIPAA Section 164.512(f)) The informationrequested must first be forwarded to Community Care legal counsel for review.In the event that the member has died, for the purposes of alerting the law, ifCommunity Care has a suspicion that such death may have resulted from criminalconduct (HIPAA Section 164.512(f)(4)).If there is evidence of criminal conduct that has occurred on our premises (HIPAASection 164.512(f)(5)).If the member (HIPAA Section 164.512(f)(6)) contacts Community Care about acrime (commission or nature of one), the location of such crime or the victim (s) ofCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 148
such crime; and the identity, description, and location of the perpetrator of such acrime.In this latter instance, the Community Care representative will notify his/her directsupervisor of the situation, and will call 911 to report this information.Community Care does not collect information on the following, in regards to organ andtissue donation or the deceased member’s wishes, information about decedents,information for fundraising purposes, or information for marketing purposes. In the eventthe Community Care would collect information on any of the above, an appropriatepolicy and procedure will be drafted.Disclosure of Information to EmployersCommunity Care does not share member identifiable data or information withemployers without the authorization of the subscriber, member or member’s legallyauthorized representative and only the specific information requested will be releasedin accordance with all federal and state laws. All authorizations for the release ofinformation will be verified by Community Care prior to the information being sent.Community Care recognizes that the member or member’s legally authorizedrepresentative, and not a subscriber (unless the subscriber is also the member orthe member’s legally authorized representative) is the preferred individual fromwhom to obtain authorization to release member identifiable information to anemployer.Community Care also acknowledges, however, that current industry practice is forthe subscriber, and not each member, to sign authorization forms and otherdocuments at the time of enrollment. Requiring the signature of each member ormember’s legally authorized representative at the time of enrollment is impractical.Community Care accepts its role as an advocate of the members’ rights and willwork to effect change in the industry to increase protections for confidential memberidentifiable data and information. Community Care follows all state and federal lawsand regulations.When Community Care is responsible for managing the enrollment process,Community Care obtains authorization from a subscriber at the time of enrollment torelease the minimum member identifiable data or information to the employer.In many instances, Community Care is not responsible for managing the enrollmentprocess. If Community Care manages behavioral health benefits through an agreementwith a managed care organization (MCO), Community Care’s policy is to releasemember identifiable data or information to the MCO, knowing that in the absence of theMCO’s agreement with Community Care, the MCO itself would be responsible formanaging behavioral health benefits and would therefore have access to the memberidentifiable data or information.In any instance where Community Care must release member identifiable data orinformation to an employer, whether self-insured or fully insured, Community CareCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 149
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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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dialogue and intervention may occur
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For any questions about providing s
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If you, as a Community Care provide
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When the precertification is for se
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ORA member expresses a readiness fo
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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 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 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
Page 182 and 183: Member identifiable information may
Page 184 and 185: Community Care extends all reasonab
Page 186 and 187: For research purposes.On behavioral
Page 188 and 189: See the policy on Transition of Pri
Page 190 and 191: Community Care does not collect inf
Page 192 and 193: The request must be in writing. Cre
Page 194 and 195: All statements to the media includi
Page 196 and 197: • 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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