Billing Manual for Community Care Network Providers

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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 Caremust verify that the member has signed an authorization to release such data orinformation to the employer. Community Care will require that the employer agree inwriting to protect all member identifiable data and information from being used in anydecisions affecting the member (HIPAA 164.504(h)(3)(iv)).Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 190
Many requests from employers for data and information can be fulfilled withdata and information that are not member identifiable. In instances where an employer requests member identifiable information,Community Care will inquire as to the proposed use of the data and information andattempt to meet the need with data and information that are not member identifiable,for example aggregated data or information. In instances where member identifiable data or information is required, CommunityCare will ensure that an authorization for the release of information is signed by themember prior to releasing implicit data to the member’s employer. In all instances, Community Care only discloses the minimal information necessaryto accomplish the purpose of the disclosure.Handling of Practitioner Specific InformationCommunity Care considers practitioner specific data and information, including but notlimited to, that used for network development, credentialing, performance evaluation,quality assurance, quality improvement, compliance auditing and peer reviewconfidential to the extent permitted by law.A practitioner’s name, professional degree, status as the member of CommunityCare’s practitioner network, business address, business telephone number, andspecialty (ies) 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 a practitioner explicitly authorizes therelease of this information.Community Care’s credentialing and recredentialing applications request that suchinformation be supplied at the discretion of a practitioner.The credentialing and recredentialing applications state that if such information issupplied, Community Care may use and disclose only the minimum amount ofinformation to members or appropriate individuals for purposes of meeting a specificmember’s needs or requests when making referrals.Practitioner files are maintained in a locked room or locked file cabinet when not inuse by Credentialing staff or the Credentialing Committee. Practitioner files stored inelectronic, magnetic, or optical format are protected with a secure password.Access to practitioner files is limited to the network management, compliance, andcredentialing staff and the Credentialing Committee.Practitioners may review the information in their file upon request except for anyinformation from the National Practitioner Data Bank (NPDB) and peer (professionaladvisor) review information. Review of NPDB information is prohibited by federalstatute.Each practitioner is informed of the right to review information in his/her file throughthe cover letter in the application packages for initial credentialing andrecredentialing.A practitioner may obtain a copy of his/her file.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 191
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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
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C/FST: Consumer/Family Satisfaction
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Medicaid/Medical Assistance identif
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APPENDICESAPPENDIX A.1. Fraud, Wast
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. The provider will also receive a
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APPENDIX A.2. ConfidentialityPOLICY
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A Facility or group practice name,
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Confidential data and information s
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The medical director or his/her des
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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
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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 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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