Billing Manual for Community Care Network Providers

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It is common for Community Care’s care managers to attend treatment team meetings,to work with groups of providers and other stakeholders in specialty areas to improvethe quality of care, and to design trainings in areas where education is requested and/orneeded. Care Managers work with members, families, providers, and others; often incommunity settings.I.E.1 Adult Mental Health, Substance Use, and Dual Diagnoses ServicesAn important function of care management is to ensure coordinated care and follow up.This is especially important when members are unfamiliar with treatment andcommunity support options. Care managers are committed to ensuring that eachindividual member has the tools needed to move forward in the recovery process.Care managers are looking for:Appropriate clinical information including discussion of treatment options with themember and/or family.The consideration of non-traditional services such as Psychiatric Rehabilitation,Diversion and Acute Stabilization, Enhanced Clinical Case Management, AcuteCase Management and Community Treatment Teams (CTT) as well as Recoveryand Peer Supports.Proactive discussion, planning, and documentation of strategies for members toutilize when dealing with crisis situations.Effective provider collaborative efforts focused on diverting members from the mostrestrictive levels of care and increasing community tenure.Identification of a need for workgroup meetings with providers, members, and otherstakeholders to establish consistent “best practices” for specific levels of care.Care managers act as consultants to the treatment team when requested. They alsoclosely monitor:Overall access to services within designated time and distance standards and gapswith needed services.The geographic make-up of the provider network ensuring a diverse network ofoptions for members.The appropriate application of Medical Necessity Criteria (MNC) and properdocumentation of supporting information for the purpose of utilization management.Coordination of care activity between behavioral health and physical healthproviders.Inquiries, complaints, and strategies to assist members with multiple and/or complexneeds.The extent to which members with a co-occurring disorder receive referrals forservices and supports that fully address their needs.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 24
In order to serve special population groups and members with high utilization of themost restrictive levels of care, a “tier” methodology is utilized to identify members whomay require special intervention by a care manager. All members have a specific caremanager assigned to them.Team members work collaboratively to serve members that have been duallydiagnosed. Mental Illness/Substance Abuse (MISA) screenings have become part of aformal program for members who are receiving both mental health and drug and alcoholservices. Care managers ask questions during regular utilization reviews to determinewhether providers are screening for dual disorders and offering appropriate referrals tomembers when a co-occurring disorder is identified. The program is monitored on anongoing basis through quality record reviews.I.E.2 Services for Children and AdolescentsCommunity Care’s child and adolescent team is a specialized group of care managerswith a strong background and expertise in the areas of child and adolescent services aswell as family systems. These care managers collaborate with providers and childrenand their families in reviewing options for treatment, coordinating services, and ensuringtimely access to needed services.These care managers:Provide parents with specific information.Monitor the prescription of services and actual service delivery for each child.Attend interagency team meetings.Monitor Behavioral Health Rehabilitative Services for Children and Adolescents(BHRSCA) through active participation with the treatment team.Monitor Residential Treatment Facility (RTF) services with an emphasis on transitionplanning.Ensure coordination of care between behavioral health providers and with thePrimary Care Physician.Ensure proper involvement of children/family services agencies or juvenile justiceagencies when needed.Facilitate coordination with schools.Facilitate physical health and behavioral health Integrated care.Consider non-traditional services such as therapeutic services in MultidimensionalTreatment Foster Care (MTFC), Multisystemic Therapy (MST) and Functional FamilyTherapy (FFT).Act as consultant to the treatment team when requested.Community Care also provides written informational material for parents, includingprevention program materials and information about Community Care’s Family AdvisoryCommittee events.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 25
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: I.E. Care Management Team“Advocat
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
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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
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If the client has given written aut
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Confidentiality policies pursuant t
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“Statement of Confidentiality”
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Findings will be reported to senior
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information and by signing this sta
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Community Care has identified circu
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NameAddress (es)Zip CodeDiagnosis (
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Community Care has the right to den
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Member identifiable information may
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Community Care extends all reasonab
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For research purposes.On behavioral
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See the policy on Transition of Pri
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Community Care does not collect inf
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The request must be in writing. Cre
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All statements to the media includi
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• The name, or title, and the tel
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APPENDIX A.4. Significant Member In
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Orientation and ongoing provider ed
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CONSENT FOR RELEASE OF INFORMATIONM
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Authorization for the Release of Dr
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___________________________________
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APPENDIX C.1. Priority PopulationsM
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Second priority is associated with
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3. Secondary Data - OMHSAS will dev
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BEHAVIORAL HEALTH MANAGED CARE ORGA
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APPENDIX E.1. Companion Guide for N
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Billing Manual for Community Care Network Providers

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