Billing Manual for Community Care Network Providers

I.E. Care Management Team“Advocates” is a word often used by others to describe Community Care’s caremanagement team because of their attention to quality, clinical effectiveness, memberchoice, and the recovery philosophy. This clinically focused team was created early inCommunity Care’s history—as the means to effectively assist members in makinginformed decisions about the services and supports that are available to them and toassist providers in quality service delivery through consultation and collaboration. Caremanagement focuses on:Adult mental health services.Services for children and adolescents.Drug and alcohol services.Dual diagnoses services.Service Precertification.Members identified as high risk.Care management uses diverse resources and team member expertise to ensure thatassistance is available to members and providers whenever needed.Care management operates 24 hours a day/seven days a week, with clinicalsupervisors on call at all hours. All care management staff have direct access toCommunity Care’s Professional Advisor staff, 24 hours a day. Care management worksclosely with other departments in Community Care, such as network management,information systems, quality management, and credentialing. In addition, CommunityCare’s prevention, outreach, communications, and training teams support members andproviders in other ways.The purpose of the care management team is to:Ensure that services are medically necessary and are being delivered at theappropriate intensity for a prescribed length of time with member participation as apart of the treatment team.Ensure coordinated care for all services and supports that the member is receivingand follow up care as a member is transitioning from one level of care to another.Monitor the quality of care in several ways, including review of treatment documents,attendance at team meetings, member and provider feedback, and analysis ofutilization information.Provide a responsive complaint and grievance process that ensures members canvoice their opinions about the care, services, and information they receive.Be available to answer questions from members and providers.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 23