Billing Manual for Community Care Network Providers

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Findings will be reported to senior management.If applicable, Community Care will alert the Secretary of Health and HumanServices, and any other state or federal government agencies, and the physicalhealth plan when necessary, of the breach in confidentiality.At times, Community Care may have interns, residents, or students who may beexposed to member protected health information (PHI) during his/her rotation. They arerequired to sign Community Care’s “Statement of Confidentiality” in the beginning oftheir rotation and review all confidentiality policies and procedures.Education related to the principles and procedures for maintaining confidentiality isrequired for all Community Care employees, staff, and volunteers at the time of hire andannually thereafter. When an employee, staff, or volunteer has a significant change inhis/her job title or assignments, his/her director/supervisor will review all confidentialitypolicies that pertain to his/her new assignments at the time of the transition.Documentation of confidentiality training will be maintained in the employee’s personnelfile located in Human Resources Department (HIPAA Section 164.530(b)(1)).Community Care considers the following data and information to be confidential:Member identifiable data and information: that is, all data and information where themember is, or could possibly be, identified.Explicitly identifiable data include, but are not limited to, member name, SocialSecurity Number, medical record number, health plan beneficiary numbers, accountnumbers, certificate/license numbers, or other identifier that can be directly linked toa specific individual.Implicitly identifiable data include, but are not limited to, member address, telephonenumber, fax numbers, electronic email addresses, date of birth or other suchinformation that, alone or in combination with other available information, can lead toidentification of a specific individual.Practitioner specific data and information, including but not limited to, that used fornetwork development, credentialing, performance evaluation, quality assurance,quality improvement, and peer review.A practitioner’s name, professional degree, status as a member of CommunityCare’s practitioner network, business address, business telephone number, andspecialty/specialties or self-identified areas of special interest are not consideredconfidential when disclosed for legitimate business purposes.Data and information related to a practitioner’s racial, cultural or ethnic background,age, religious affiliation, sexual orientation, and ability to communicate in languagesother than English, is confidential unless the practitioner explicitly authorizes therelease of this information.Practice/group specific and facility specific data and information, including that it isused for but not limited to, network development, organizational assessment andcontracting, performance evaluation, quality assurance, and quality improvement.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 172
A facility or group practice name, status as a participant in Community Care’snetwork, business address, business telephone number, and services offered arenot considered confidential when disclosed for legitimate business purposes.Community Care’s business data and information considered confidential includes but isnot limited to:Salaries.Policies and procedures.Finances.Business plans.Practitioner, practitioner group, and facility participants in Community Care’s networkwhen such information is not being released for legitimate business purposes.Proposals to potential or current customers.Information disclosed to Community Care in confidence by a third party.Information including quality assurance, quality improvement and performanceevaluation data and information where practitioners, practitioner groups, or facilitiesare not individually identifiable.Community Care has an array of security provisions to protect confidential data andinformation, including:Differential access based on job responsibilities to information maintained inCommunity Care’s information system.Physical lock and key arrangements.Electronic security systems.Mandatory compliance with Community Care’s Statement of Confidentiality.The following provisions are in effect for all Community Care representatives:Divulging computer passwords and security system pass codes is prohibited.Building access codes and keys may not be shared with any individual who does nothave the right to such access codes or keys.All computers that have the ability to access confidential data or information mustbe:• Protected with a confidential log-in password.• Turned or logged off at the end of the workday.• Protected with a confidential screen-saver password in the event that thecomputer is turned on and logged on while the computer user is away fromhis/her work area.Community Care’s agents, contractors, employees, staff, and volunteers may notaccess or view confidential data or information unless required by his/her duties orresponsibilities for, or on behalf of, Community Care. The “Statement of Confidentiality”includes a statement that an employee has access to sensitive and confidentialCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 173
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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
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Community Care Behavioral Health Or
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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 168 and 169: Confidentiality policies pursuant t
Page 170 and 171: “Statement of Confidentiality”
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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