- Page 5 and 6:
APPENDIX A.2. Confidentiality 130AP
- Page 7 and 8:
Clinical Fax by County:Adams 1-866-
- Page 9 and 10:
Outpatient Therapy 1MD OutpatientMe
- Page 11 and 12:
Functional Familytherapy (FFT)Multi
- Page 13 and 14:
Non-Acute PartialHospitalizationNot
- Page 15 and 16:
I.A. Code of EthicsCommunity Care
- Page 17 and 18:
esources and evaluated on their pro
- Page 19 and 20:
Confidentiality policies including
- Page 21 and 22:
Within 30 minutes for urban areas.W
- Page 23 and 24:
I.E. Care Management Team“Advocat
- Page 25 and 26:
In order to serve special populatio
- Page 27 and 28:
Psychiatric Rehabilitation Clubhous
- Page 29 and 30:
always be considered in light of th
- Page 31 and 32:
Tell their provider everything they
- Page 33 and 34:
and calls received on the programs
- Page 35 and 36:
II.D.1e EvaluationIndividuals parti
- Page 37 and 38:
II.D.2b GoalsThe goals of Community
- Page 39 and 40:
II.D.3 Providers’ Role in the Pre
- Page 41 and 42:
Community Care has a total of 30 ca
- Page 43 and 44:
Department of Health and provide in
- Page 45 and 46:
An explanation of the grievance pro
- Page 47 and 48:
Upon request, the member will be as
- Page 54 and 55:
Notices must be in alternate format
- Page 56 and 57:
Community Care is a party to the he
- Page 58 and 59:
The following sections provide info
- Page 60 and 61:
members, practitioners are asked to
- Page 62 and 63:
Accreditation of Healthcare Organiz
- Page 64 and 65:
III.B.4 Facility ReassessmentFacili
- Page 66 and 67:
present relevant information, and t
- Page 68 and 69:
contracting, performance evaluation
- Page 70 and 71:
the implementation and application
- Page 72 and 73:
III.C.4 Ability to Give Informed Au
- Page 74 and 75:
When such disclosure to health care
- Page 76 and 77:
Practitioners are informed of the r
- Page 78 and 79:
Medication(s) that have been prescr
- Page 80 and 81:
III.E. Clinical Practice Guidelines
- Page 82 and 83:
Community Care has developed a plan
- Page 84 and 85:
eing served and uses strategies to
- Page 86 and 87:
dialogue and intervention may occur
- Page 88 and 89:
For any questions about providing s
- Page 90 and 91:
If you, as a Community Care provide
- Page 92 and 93:
When the precertification is for se
- Page 94 and 95:
ORA member expresses a readiness fo
- Page 96 and 97:
IV.E.3 Transition of Care to anothe
- Page 98 and 99:
Billing ManualCommunity Care Behavi
- Page 100 and 101:
Even though an authorization may be
- Page 102 and 103:
Timely File requests are to be mail
- Page 104 and 105:
Provide an alternative to the use o
- Page 106 and 107:
Required Claim FieldsIn the followi
- Page 108 and 109:
24C EMG Not required24D Procedure C
- Page 110 and 111:
17 Discharge Status Required forINP
- Page 112 and 113:
67a-q Diag. Code Required68 Unlabel
- Page 114 and 115:
• Explanation of Benefits (EOB) i
- Page 116 and 117:
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 168 and 169: Confidentiality policies pursuant t
- 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 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