Billing Manual for Community Care Network Providers

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3. Secondary Data - OMHSAS will develop data exchange agreements with otherstate agencies, as feasible; to obtain regularly scheduled data file extracts that willbe loaded into the POMS central database. Data exchanges with state agenciessuch as the Department of Corrections, State Police, and the Department ofEducation are under development.4. Consumer/Family Satisfaction Reports - There will be standardized measuresadministered by the BH-MCO. The BH-MCO will submit reports of findings to theDPW. A survey will be conducted annually.5. BH-MCO Consumer Registry File - BH-MCOs will maintain a computerizedregistry of their enrollees who have accessed behavioral health services. Theregistry is comprised of a minimum data set including clinical descriptions such aspriority population and critical dates during the episode of care such as date of firstservice request, registration date, and termination date. These data will be submittedby the BH-MCOs to the POMS central database.6. BH-MCO Quarterly Status File - BH-MCOs will maintain a computerized fileconcerning the status of priority populations. The file will be updated on a calendarquarter basis for each enrollee in the priority population. The quarterly status file iscomprised of a minimum data set including outcome measures such asvocational/educational status and independence of living arrangement. These datawill be submitted by the BH-MCOs to the POMS central database on a regularschedule.Please note: Providers contracted with the BH-MCO are required to submit POMS data quarterly for allnew members receiving behavioral health services during the quarter. Providers are expected to submitupdates to POMS data every six months for members in continuous care. Providers may submit POMSdata by completing individualized member specific POMS data collection paper surveys or by electronicfile submission using specifications developed by Community Care. For those submitting paper POMSdata, providers will be notified of members for whom POMS data is required each quarter through theconfidential mailing of individualized, member specific POMS Data Collection Survey forms. Instructionsfor completing the POMS Data Collection Survey are printed on the back of each individual form.7. Performance Indicator Reports - On a regular schedule, DPW will produce fromthe POMS central database a set of performance indicators that measure theperformance of each BH-MCO consistent with the outcome dimensions outlined inthe attached table of outcome measures. The performance indicator reports will beissued by DPW on a regular schedule to all relevant DPW monitoring staff, the BH-MCOs and other stakeholder groups.CONTINUOUS QUALITY IMPROVEMENT (CQI) PROCESSDPW encourages the BH-MCOs to implement a continuous quality improvement (CQI)process based upon Deming’s 14-point program adapted to the health care industry,and Joint Commission on Accreditation of Health Care Organization (JCAHO)guidelines. The overall process should include:Delineating the scope of the services to be monitored and improved.Identifying the important aspects of the services whose quality should be examinedand improved.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 212
Identifying indicators (including but not limited to the performance indicatorsestablished by DPW) that will be used to monitor the quality, accessibility, andappropriateness of the important aspects of services.Establishing thresholds (including but not limited to the thresholds established byDPW) for the review of indicators that become “flags” signaling the need for furtheranalysis of the causes for the data reported to DPW.Collecting data pertaining to each indicator and comparing the aggregate level ofperformance with the threshold for analysis. If the threshold is not reached, furtheranalysis may not be necessary.Initiating analyses of other important aspects of services when thresholds have beenreached.Taking actions to improve the aspects of services.Reporting the findings to the organizations involved, including a report of findings toDPW on a regular schedule. Monitoring and analysis are continued in order toidentify any future deficiencies in services and to improve quality. DPW monitoringstaff will review the CQI reports of findings submitted by the BH-MCOs. DPWmonitoring staff will provide feedback to BH-MCOs indicating:• Concurrence with the BH-MCOs explanation/cause of the performance Indicatorfindings and actions proposed by the BH-MCOs to improve performance (and/orcorrect deficiencies); or• Offer alternative explanations/causes for the performance indicator findingsand/or recommended alternative actions to improve performance (and/or correctdeficienciesCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 213
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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
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If a member is granted access to re
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Under some circumstances, it may be
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164.504(e)(ii)(A)).They will take a
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must verify that the member has sig
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esults, billing records, and treatm
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equestor destroy the information, o
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The member has the right to request
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Policy on Release of Information Re
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y the written authorization of the
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Page 164 and 165: Current patients or clients or the
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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
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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
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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 214 and 215: BEHAVIORAL HEALTH MANAGED CARE ORGA
Page 216 and 217: APPENDIX E.1. Companion Guide for N
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