Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
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II. About <strong>Community</strong> <strong>Care</strong> HealthChoices Members<strong>Community</strong> <strong>Care</strong>’s HealthChoices members are individuals <strong>for</strong> whom <strong>Community</strong> <strong>Care</strong>has been contracted to manage behavioral health—mental health or drug and alcohol—services (See Guidelines <strong>for</strong> Obtaining Approval <strong>for</strong> In-plan Services at the beginning ofthis Provider <strong>Manual</strong>).When <strong>Community</strong> <strong>Care</strong> receives enrollment in<strong>for</strong>mation, our Customer ServicesDepartment verifies eligibility. Customer services representatives serve as the point ofcontact <strong>for</strong> members until they use a service other than routine outpatient behavioralhealth services, at which time a care manager is assigned.<strong>Community</strong> <strong>Care</strong> offers a toll-free Members’ Line that is staffed 24 hours a day, sevendays a week to address all member inquiries and concerns, including services covered,selecting a behavioral health provider, out-of-area care, and complaints. In accordancewith quality standards, the member is able to speak to a customer servicesrepresentative at any time of the day or night. Every members is encouraged to read the<strong>Community</strong> <strong>Care</strong> Member Handbook.In<strong>for</strong>mation concerning members and services that providers need to know is describedin the following Sections:A. Member Rights and ResponsibilitiesB. Member Help in Selecting <strong>Providers</strong>C. Member SatisfactionD. Member Behavioral Health Preventive Health ProgramsE. Member Complaint and Appeal ProceduresF. Member Grievances<strong>Providers</strong> are asked to urge members who have questions about their behavioral healthcare to call the toll-free <strong>Community</strong> <strong>Care</strong> Members' Lines (Customer service phonenumbers are listed by county in the Contact In<strong>for</strong>mation section of this manual).II.A. Member Rights and ResponsibilitiesAll members of <strong>Community</strong> <strong>Care</strong> have certain rights and responsibilities. Every staffperson and provider has the obligation and responsibility to know these rights andresponsibilities and to support them in daily operations.Member responsibilities are intended to serve as guidelines to help the member,provider and others work cooperatively and effectively <strong>for</strong> the member's benefit.Member responsibilities are not a threshold (required) standard of behavior and must<strong>Community</strong> <strong>Care</strong> Provider <strong>Manual</strong> | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 28