Billing Manual for Community Care Network Providers

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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
APPENDIX F.1. Companion Guide for North Central CountiesGuidelines for Obtaining Approvalfor In-Plan and SupplementalServices – Mental HealthCommunity Treatment TeamPerformance StandardsDiversion and Acute Stabilization(DAS) Performance StandardsCommunity Care Behavioral Health OrganizationHealthChoices Provider Manual Companion Guide forHealthChoices North CentralPage 8 Mobile, Telephone, and Walk-In Crisis servicesare authorized via the submission of a FacsimileTransmittal request form within 24 hours of eachmember occurrence.* Community Treatment Teams (CTT) is not acovered service.Diversion and Acute Stabilization (DAS) is not acovered service.* Performance standards can be found on the Community Care website at:www.ccbh.com/providers/phealthchoices/performancestandardsCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 217
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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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If minor consents to treatment or c
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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 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
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Billing Manual for Community Care Network Providers

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