Billing Manual for Community Care Network Providers

APPENDIX E.1. Companion Guide for Northeast CountiesCommunity Care Behavioral Health OrganizationHealthChoices Provider Manual Companion Guide forLackawanna, Luzerne, Susquehanna, and Wyoming CountiesTable of Contents Page 4 The Northeast Behavioral Healthcare Consortium(NBHCC) will publish member handbooks.Guidelines for Obtaining Approvalfor In-Plan and SupplementalServices – Mental HealthPage 8 Mobile, Telephone, and Walk-In Crisis servicesare authorized via the submission of a FacsimileTransmittal request form within 24 hours of eachmember occurrence.Initial non-MD Evaluation is not a covered service.Designated Providers only.NBHCC counties do not differentiate the benefitfor levels of partial hospitalization mental health;all partial services follow a standard partial benefitGuidelines for Obtaining Approvalfor In-Plan and SupplementalServices – Chemical DependencySection I.C. Overview of QualityManagementAcute Partial HospitalizationStandardsCommunity Treatment TeamPerformance StandardsDiversion and Acute Stabilization(DAS) Performance StandardsDrug and Alcohol PartialHospitalization PerformanceStandardsSchool Based Partial HospitalizationPrograms Performance StandardsPage 12Page 17and reimbursement.Initial non-MD Evaluation is not a covered service.Designated Providers only.NBHCC clinical parameters for Partial D&A are asfollows:Must meet PCPC; Partial D&A services must bebetween three and four hours per day; maximum12 hours per week. In general, member is notexpected to be receiving other treatment (asopposed to support or rehabilitation) services inany other levels of care during partial hospitalstay. Length of stay should not exceed four to sixweeks unless approved by Community Care.Quality Management Plans and Responsibilitieswill be developed in concert with NBHCC.* NBHCC counties do not differentiate the benefitfor levels of partial hospitalization; all partialservices follow a standard partial benefit andreimbursement.* Performance standards can be found on the Community Care website at:www.ccbh.com/providers/phealthchoices/performancestandardsCommunity Treatment Teams (CTT) are not acovered service.Diversion and Acute Stabilization (DAS) is not acovered service.D&A Partial Performance Standards do notcurrently apply. NBHCC counties do notdifferentiate the benefit for levels of hospitalizationdrug & alcohol outside of clinical parametersoutlined on Page 10.School Based Partial Performance Standardswere developed for Approved Private Schools orPrivate Academic School Settings. NBHCC hasestablished a differential code for partial hospitalservices within a school setting but will notdifferentiate the benefit or reimbursement.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 216