Billing Manual for Community Care Network Providers

I.E.3 Pre-certification TeamCommunity Care maintains a dedicated team of care managers to conductprecertification reviews for acute levels of care. These care managers ensure thatindividuals’ needs and strengths have been assessed, that the specific level of carerequested meets MNC and that the requested level of care provides the least restrictiveenvironment for the member to continue the recovery process. In addition, the caremanagers on the precertification team may assist the member and provider inidentifying options and facilitating diversion planning. These care managers will alsofacilitate coordination of care efforts based on the member’s treatment history, currentauthorized services and active crisis plan.I.E.4 High Risk InterventionThis specific team of care managers works with members and their providers to resolvecomplex or high risk factors which impact the member’s ability to progress towardsrecovery. Face to face or telephone contact is focused on both the member andprovider. Because medical conditions often co-exist with a behavioral health diagnosis,coordinating care with physical health practitioners is also a priority.This team’s activities are driven by the needs and strengths of the individual memberwith frequent consultation with the Community Care professional advisors.Care managers focus on performance standards. They ensure that quality standards(performance standards) are met. Community Care created these standards inconjunction with providers, members, and other stakeholders with the goal of providingconsistent, high-quality care to all members. We accomplish this goal by offering writtenand specific quality standards by level of service and by using effective qualitymonitoring.To date, Community Care has created performance standards for:Acute Partial HospitalizationBehavioral Specialist ConsultationBHRS for Autism Spectrum DisordersCommunity Treatment Teams (CTT)Diversion and Acute Stabilization/RespiteDrug and Alcohol – Medically Monitored Short-Term Rehabilitation ProgramsDrug and Alcohol Partial HospitalizationFamily-Based Mental Health ServicesFamily-Focused Solution BasedIndividualized Residential Treatment/CRRInpatient ServicesMobile TherapyOutpatient ServicesPsychiatric RehabilitationCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 26