Billing Manual for Community Care Network Providers

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The request must be in writing. Credentialing staff will send a copy of a practitioner’s file to him/her within 10business days of receipt of the written request for the file. This file when mailed willbe sealed in an envelope marked confidential. NPDB information is not included. Peer review information is not included. Practitioners are notified by the credentialing staff of any information obtained duringcredentialing or recredentialing activities that varies substantially from theinformation provided by the practitioner. Practitioners have the right to correct erroneous information. Practitioners may submit any corrections in writing or additional documents to theCredentialing Department. Credentialing staff will document any verbal information or corrections provided by apractitioner in the file including the date and signature of the individual who obtainsthe information.Informing Providers about ConfidentialityThe following policies and procedures are included in Community Care’s ProviderManual and are updated as needed: General Confidentiality Provisions. Oversight of Confidentiality Practices. Collecting and Using 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. Practitioner Office Confidentiality.Practitioner Office ConfidentialityMember identifiable data and information maintained in paper based or removablecomputer storage media must be maintained under lock and key, either in lockedcabinets or in a locked area.Member identifiable data and information includes, but is not limited to, medicalrecords, appointment books, patient reminder cards, correspondence, laboratoryresults, 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 mediaCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 192
must 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’s normalcourse of performing work for Community Care: 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.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 193
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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
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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 190 and 191: Community Care does not collect inf
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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