Billing Manual for Community Care Network Providers

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esults, billing records, and treatment plans whether maintained on paper, magneticdisk or tape, optical disk, or any other removable storage medium.These paper-based records and removable computer storage media must be lockedexcept at times when the practitioner or another member of the office staff, who isauthorized to access treatment records, is present.When unlocked, these paper-based records and removable computer storage mediamust be maintained in a secure location where they are not accessible tounauthorized individuals.In addition, when unlocked, these paper-based records must be maintained in amanner that their content is not visible to unauthorized individuals.Computers used to store member identifiable data or information must be protectedwith a password.Password protection is not required if all persons at the practice site are authorizedto access, for legitimate business purposes, the member identifiable data orinformation stored on the computer; and the computer is located in a secure locationnot accessible to unauthorized individuals.When a computer is used to store member identifiable data or information, themonitor is positioned such that it is not visible to unauthorized individuals.If email is used to transmit member-identifiable data or information, the email isflagged as confidential and a confidentiality notice is prominently displayed at thebeginning of the email that conveys a message substantively similar to the following:“This email 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 email in error, pleasenotify the sender by return email, securely delete this file and any electronic ormagnetic copies, and destroy any paper copies.”Facsimile machines are in secured areas where faxes may not be intercepted orviewed by individuals not authorized to access member identifiable data andinformation. If facsimile machines are used to transmit member identifiable data orinformation, a confidentiality notice is prominently displayed on the facsimile coversheet that conveys a message substantively 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.”Handling of Community Care’s Business InformationCommunity Care’s representatives and business associates may not releaseconfidential business data and information (as described in the procedure on GeneralConfidentiality Provisions) except for legitimate business purposes and within theframework of the representative’s job responsibilities or the business associate’snormal course of performing work for Community Care:Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 152
As described in Community Care’s policies, procedures, program descriptions andwork plans, or as authorized by a member of Community Care’s seniormanagement.All requests for confidential business information which are not explicitly addressed andauthorized by Community Care’s policies and procedures or other official documentsshould be referred to the manager of the department for documentation and follow-up.All statements to the media including press releases and interviews are made by orauthorized by Community Care’s Chief Executive Officer.SubpoenasMember identifiable data and information must not be released if a subpoena isserved without first consulting Community Care’s legal counsel:The Community Care representative receiving the subpoena should immediatelysend the subpoena, via facsimile if necessary, to Community Care’s legal counsel.If the Community Care representative receiving the subpoena is not a member ofmanagement, he or she should immediately contact his or her supervisor to act onthe matter.Legal counsel, in conjunction with appropriate Community Care staff, employees,and the treating practitioner, will determine the appropriate course of action.When the information is needed to prevent further harm to the member, CommunityCare may release protected health information in response to a law enforcementofficial’s request with or without the authorization of a member who is suspected ofbeing a victim of a crime (HIPAA Section 164.512(f)(3)).Information may be released to law enforcement officials for court proceedings or aninvestigation, after it is forwarded to Community Care’s legal counsel. CommunityCare will ensure that the proceedings and persons requesting the member’sinformation have made a good faith attempt to contact the member, or his/her legallyauthorized representative, to inform him/her that their protected health information isbeing requested before it is released (HIPAA Section 164.512(e)).If the officials are unable to locate the member and they have shown reasonable effortsin an attempt, then Community Care will release information if (HIPAA Section164.512(e)):There is documentation to support our efforts in trying to find the member.A written notice was sent to the member’s last known address and the member wasgiven sufficient time to respond or raise objections.Once time has elapsed:• Proof that there are no objections filed by the member.• If there are any objections filed, they have been resolved through the court or anadministrative tribunal.• The information released is only to be used for the litigation or proceeding.• Once this information is no longer needed then, Community Care requires thatCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 153
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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
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Billing ManualCommunity Care Behavi
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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 148 and 149: 164.504(e)(ii)(A)).They will take a
Page 150 and 151: must verify that the member has sig
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
Page 198 and 199: APPENDIX A.4. Significant Member In
Page 200 and 201: 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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