Billing Manual for Community Care Network Providers

Tell their provider everything they know about their physical and mental health. Also,they need to tell their provider what medicines they are taking, including over-thecounter(store bought) medicine(s).Tell their family doctor or primary care physician (PCP) about any counselingtreatment.Carry their ACCESS, physical health plan (or ACCESS Plus), and Community CareID cards with them.Go to a Community Care participating hospital in an emergency, if possible.Members need to call Community Care within 24 hours if they have been seen foran emergency at a hospital that is not in the Community Care provider network.Keep their appointments. Members need to call ahead to cancel if they must.Understand their health problems and work together with their provider and agreeupontheir treatment plan.Follow the treatment plan they agreed upon with their provider.Tell their provider if they want to stop or change treatment.Tell Community Care and their provider about any other insurance they have.Tell Community Care and their provider right away if their Medicaid status changes.Tell Community Care and their provider right away if they move.II.B. Member Help in Selecting ProvidersCommunity Care customer services representatives assist members who ask for help inidentifying a provider who will meet their needs. To obtain a selection of providers in therequested specialty, location, etc., the representative consults Community Care'sPsychConsult MCO ® database, which contains the most current information providershave supplied to Community Care. A representative may disclose the followinginformation about prospective providers to help the member choose:SpecialtyOffice location, telephone number, and office hoursGenderProfessional credentialsLanguages spoken by provider/provider staff if this information was disclosed on thecredentialing/recredentialing or assessment/reassessment application formA representative may not disclose providers' malpractice limits and/or history, NationalPractitioner Data Base information, or Drug Enforcement Agency (DEA) number. Arepresentative will not refer members to a provider who is not currently accepting newclients or indicate a preference of one provider over another. If the member requiresadditional assistance in selecting a provider, the call will be referred to a care manager.Members may ask to change their provider at any time.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 31