Billing Manual for Community Care Network Providers

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If minor consents to treatment or counseling related to the diagnosis or treatment ofdrug or alcohol abuse and dependency without the involvement of a parent orguardian, the written authorization of the minor will be obtained by Community Careprior to the release of patient utilization records.Mental Health Services. The Mental Health Procedures Act authorizes any person14 years of age or older who believes that he/she needs treatment and understandsthe nature of treatment to consent to examination and treatment. A parent orguardian may consent to treatment of children less than 14 years of age.Community Care will not release the utilization records of any member without thewritten authorization of the person providing consent to treatment.Significant Member Incidents: Reporting of Child Abuse. In accordance withapplicable law governing child abuse, providers are required to report all incidents ofsuspected child abuse. Community Care will ensure that a Childline phone numberis made available to providers and conspicuously listed in the Provider Manual alongwith the appropriate forms for reporting and documenting suspected incidents ofabuse.Release of Information Related to Treatment of Mental HealthCommunity Care complies with pertinent provisions of the Mental Health ProceduresAct, the Mental Health and Mental Retardation Act of 1966 and regulations promulgatedby the Pennsylvania Department of Public Welfare and set forth in the Mental HealthManual at 55 Pa. Code §§5100.31 et seq. defining appropriate release of informationrelated to mental health treatment.Persons seeking or receiving services from a mental health provider may expect thatinformation will be treated with respect and confidentiality so that trust and confidence intherapeutic intervention may develop. Mental health records subject to this policyinclude, but are not limited to, written clinical information, observations and reports, orfiscal documents relating to the member which are required or authorized to beprepared by the Mental Health Procedures Act or by the Mental Health and MentalRetardation Act of 1966, and any central files and reports which are required to bemaintained by the Department of Public Welfare or other statutes or regulationsregarding services for mental health programs.Community Care will not release the records of any Member, 14 years of age or older,who understands the nature of the documents to be released and the purpose ofreleasing them without the written authorization of the member.For the member who lacks this understanding, any person chosen by the member mayexercise this right (if that person is found by the administrative head of the facility or hisdesignee to be acting in the member’s best interest).If the member is less than 14 years of age or has been adjudicated legally incompetent,control over the release of records may be exercised by a parent or guardian.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 162
Exception: Records concerning persons receiving mental health treatment servicesmay be released without the written authorization of the member only in thosespecific circumstances defined in 55 Pa. Code §§5100.32, §5100.35, §5100.36 and§5100.38, attached. (This is a reproduction of the original document, 55 § 5100.32Mental Health Manual Pt.VII.)Nonconsensual release of informationRecords concerning persons receiving or having received treatment shall be keptconfidential and shall not be released nor their content disclosed without the consentof a person given under § 5100.34 (relating to consensual release to third parties),except that relevant portions or summaries may be released or copied as follows:• To those actively engaged in treating the individual, or to persons at otherfacilities, including professional treatment of State Correctional Institutions andcounty prisons, when the person is being referred to that facility and a summaryor portion of the record is necessary to provide for continuity of proper care andtreatment.• To third party payors, both those operated and financed in whole or in part byany governmental agency and their agents or intermediaries, or those who areidentified as payor or copayor for services and who require information to verifythat services were actually provided. Information to be released without consentor court order under this subsection is limited to the names, dates, types, andcosts of therapies or services, and a short description of the general purpose ofeach treatment session or service.• To reviewers and inspectors, including the Joint Commission on Accreditation ofHealthcare Organizations (JCAHO) and Commonwealth licensure or certification,when necessary to obtain certification as an eligible provider of services.• To those participating in Professional Standards Review Organization (PSRO) orutilization reviews.• To the administrator, under his duties under applicable statutes and regulations.• To a court or mental health review officer, in the course of legal proceedingsauthorized by the act or this chapter.• In response to a court order, when production of the documents is ordered by acourt under § 5100.35 (relating to release to courts).• To appropriate departmental personnel § 5100.38 (relating to child or patientabuse).• In response to an emergency medical situation when release of information isnecessary to prevent serious risk of bodily harm or death. Only specificinformation pertinent to the relief of the emergency may be released on anonconsensual basis.• To parents or guardians and others when necessary to obtain consent to medicaltreatment.• To attorneys assigned to represent the subject of a commitment hearing.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 163
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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
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Timely File requests are to be mail
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Provide an alternative to the use o
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Required Claim FieldsIn the followi
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24C EMG Not required24D Procedure C
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17 Discharge Status Required forINP
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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 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
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Page 160 and 161: y the written authorization of the
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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
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
Page 202 and 203: CONSENT FOR RELEASE OF INFORMATIONM
Page 204 and 205: Authorization for the Release of Dr
Page 206 and 207: ___________________________________
Page 208 and 209: APPENDIX C.1. Priority PopulationsM
Page 210 and 211: 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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