Billing Manual for Community Care Network Providers

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All statements to the media including press releases and interviews are made by orauthorized by Community Care’s Chief Executive Officer.SubpoenasMember identifiable data and information must not be released if a subpoena isserved without first consulting Community Care’s legal counsel.The Community Care representative receiving the subpoena should immediatelysend the subpoena, via facsimile if necessary, to Community Care’s legal counsel.If the Community Care representative receiving the subpoena is not a member ofmanagement, he or she should immediately contact his or her supervisor to act onthe matter.Legal counsel, in conjunction with appropriate Community Care staff, employees,and the treating practitioner, will determine the appropriate course of action.When the information is needed to prevent further harm to the member, CommunityCare may release PHI in response to a law enforcement official’s request with orwithout the authorization of a member who is suspected of being a victim of a crime(HIPAA Section 164.512(f)(3)).Information may be released to law enforcement officials for court proceedings or aninvestigation, after it is forwarded to Community Care’s legal counsel. CommunityCare will ensure that the proceedings and persons requesting the member’sinformation have made a good faith attempt to contact the member, or his/her legallyauthorized representative, to inform him/her that their PHI is being requested beforeit is released (HIPAA Section 164.512 (e)).If the officials are unable to locate the member and they have shown reasonable effortsin an attempt, then Community Care will release information if (HIPAA Section 164.512(e)):There is documentation to support their efforts in trying to find the member.A written notice was sent to the member’s last known address and the member wasgiven sufficient time to respond or raise objections.Once time has elapsed:• Proof that there are no objections filed by the member.• If there are any objections filed, they have been resolved through the court or anadministrative tribunal.• The information released is only to be used for the litigation or proceeding.• Once this information is no longer needed then, Community Care requires thatrequestor destroy the information, or to return it so that it can be destroyed.A Member’s Right to Amend Protected Health InformationIn accordance with HIPAA (Section 164.526), the member has the right to amendhis/her PHI if desired. The member may request to amend his/her information bywriting a letter to the privacy officer at Community Care including a reason why thisCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 194
information needs to be amended.The privacy officer will review the member’s request and will respond in writingwithin 30 days.If the information requested is not on site, then Community Care will retrieve theinformation within 60 days.If needed Community Care may extend the retrieval an additional 30 days providedthat the member is sent a written statement with the reasons for delay and a date bywhich we will have the information.Community Care will only have one such extension of time for action.If the member is granted the right to amend his/her PHI then the privacy officer willoversee the process to amend the PHI.The privacy officer or his/her designee will record the granted request to amendprotected health information in the Member Request to Amend Protected HealthInformation log, which will be maintained by the privacy officer or his/her designee.The privacy officer will inform the member that the original information will remainintact. The privacy officer (or his/her designee) and the member will discuss how thisinformation will be amended. Including what type of statement will be attached to allfuture releases such as “this information, as requested by the member, wasamended.” The privacy officer will notify the manager of the file room to have themember’s chart pulled.A sticker will be placed on the front of the member’s utilization record that says:“AMENDED PROTECTED HEALTH INFORMATION.” The privacy officer or his/herdesignee will also write a brief statement to be included in the member’s file, on howthis information that was requested by the member was amended.There will be a flag in PsychConsult to inform Community Care employees that thisinformation was amended.Community Care’s privacy officer will write a formal notification alerting all thenecessary staff and providers that the member’s PHI was amended and include abrief statement on how and why.Once this process is completed the privacy officer or his/her designee will send awritten letter to the member including that his/her request to amend his/her protectedhealth information was granted, including a brief description on how it was amended.If the member is denied the right to amend his/her PHI, the privacy officer, or his/herdesignee will:Record in the Member Request to Amend Protected Health Information Log that therequest was denied.Send the member a letter including:• The decision.• The reason for the denial.• A description of the appeals process.• The right to, and process for, filing an appeal.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 195
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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
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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 192 and 193: The request must be in writing. Cre
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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