Billing Manual for Community Care Network Providers

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Confidentiality policies pursuant to all relevant state and federal regulations incompliance with CPL 032 policy sections listed below:• General Confidentiality Provisions.• Oversight of Confidentiality.• Collecting and Using Member Identifiable Information.• Handling of Member Identifiable Information.• Informing Members about Confidentiality.• Ability to Give Informed Authorization.• Member Access to Utilization Records.• Disclosure of Information.• Disclosure of Information to Employers.• Handling of Practitioner Specific Information.• Informing Providers About Confidentiality.• Practitioner Office Confidentiality.• Handling of Community Care’s Business Information.• Subpoenas.• A member’s right to amend PHI.• A member’s right to an accounting of disclosures of PHI.Confidentiality policies pursuant to all relevant state and federal regulations incompliance with CPL 033 policy sections listed below:• Confidentiality: Terms and Disclosure Policy• Confidentiality: Compliance With State and Federal Laws• Notice to Accompany Information Released Pursuant to Written Authorization forDisclosure• Release of HIV-Related Information• Release of Information Related to Treatment of Minors• Release of Information Related to Treatment of Mental Health• Release of Information Related to Drug and Alcohol Dependency and Treatment• Community Care Staff Having Knowledge of or a Relationship with the Member• Confidentiality and Privacy Training for Community Care StaffThe Notice of Privacy Practices for PHI include:• Safeguarding the Member’s Information.• Disclosure of Information for the purposes of Treatment, Payment and HealthCare Operations.• Disclosures of Information:• When required by law.• For public health activities.• Health oversight activities.• Lawsuits and disputes.• Law enforcement.• Coroners, medical examiners, funeral directors, and organ donation.• Research purposes.• Serious threats.• National security and intelligence activities.• Protective services for the President and others.• Military and veterans.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 168
• Workers compensation.• Inmates.• Disclosures of Information in which the member’s signature is required• The member’s Rights Regarding PHI:• To request restrictions on the uses and disclosures of their PHI.• The right to choose how Community Care will contact them.• The right to inspect and copy PHI.• The right to request an amendment of their PHI.• The right to an accounting of disclosure.• The right to obtain a copy of this notice.• Privacy Notice.• How the member receives a copy of changes made to the Privacy Notice.• How the member may file a complaint about our Privacy Practices.• How the member may have questions or concerns regarding privacy or theNotice of Privacy addressed.• The effective date for the Notice of Privacy.• Reporting inappropriate use of member information.• Non-Retaliation Policy.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 169
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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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67a-q Diag. Code Required68 Unlabel
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• Explanation of Benefits (EOB) i
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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
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 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
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
Page 212 and 213: 3. Secondary Data - OMHSAS will dev
Page 214 and 215: BEHAVIORAL HEALTH MANAGED CARE ORGA
Page 216 and 217: APPENDIX E.1. Companion Guide for N
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Billing Manual for Community Care Network Providers

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