Billing Manual for Community Care Network Providers

II. About Community Care HealthChoices MembersCommunity Care’s HealthChoices members are individuals for whom Community Carehas been contracted to manage behavioral health—mental health or drug and alcohol—services (See Guidelines for Obtaining Approval for In-plan Services at the beginning ofthis Provider Manual).When Community Care receives enrollment information, our Customer ServicesDepartment verifies eligibility. Customer services representatives serve as the point ofcontact for members until they use a service other than routine outpatient behavioralhealth services, at which time a care manager is assigned.Community Care 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 theCommunity Care Member Handbook.Information concerning members and services that providers need to know is describedin the following Sections:A. Member Rights and ResponsibilitiesB. Member Help in Selecting ProvidersC. Member SatisfactionD. Member Behavioral Health Preventive Health ProgramsE. Member Complaint and Appeal ProceduresF. Member GrievancesProviders are asked to urge members who have questions about their behavioral healthcare to call the toll-free Community Care Members' Lines (Customer service phonenumbers are listed by county in the Contact Information section of this manual).II.A. Member Rights and ResponsibilitiesAll members of Community Care 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 for the member's benefit.Member responsibilities are not a threshold (required) standard of behavior and mustCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 28