Billing Manual for Community Care Network Providers

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II.C. Member SatisfactionMember satisfaction is the highest priority for Community Care. Dedicated to improvingthe satisfaction of members, Community Care contracts an outside survey company toconduct an annual Member Satisfaction Survey for members and family members ofchildren and adolescents. The survey tool used is the Experience of Care and HealthOutcomes (ECHO) Survey. Information from this survey is important to qualitymanagement programs such as the Comprehensive Provider Evaluation Process (SeeSection III.I.).Community Care has modified the ECHO Survey tool to include additional questionsthat help determine if members and family members of children and adolescents areknowledgeable about and satisfied with additional Community Care core functions suchas satisfaction with BHRS authorizations.In addition, because the ECHO survey is widely used, results on the ECHO survey canbe used to benchmark the satisfaction results of surveys against national averages. Allresults are analyzed, reviewed, and presented to Community Care’s Quality and CareManagement Committee (QCMC). The committee identifies areas for improvement andinterventions are developed to increase satisfaction in those targeted areas.Community Care additionally uses data about member complaints to assess membersatisfaction with care and services. The QCMC reviews and analyzes complaint dataroutinely and, as appropriate:Identifies opportunities for improvement.Determines interventions to improve performance.Oversees implementation of interventions to improve performance.Establishes re-measurement schedules to measure the effectiveness ofperformance improvement interventions.The categories used to analyze member complaints include access to services (SeeSection IV.D.), attitude and service, quality of care (See Complaint Section II.E), culturalcompetence (See Section III.H), and billing (Section V).II.D. Member Behavioral Health Preventive Health ProgramsCommunity Care offers preventive health programs for members. Each preventivehealth program is designed to help members learn new ways to make their treatmentmore helpful. The programs are free to members and are designed to complement theinformation about diagnosis and treatment that members receive from their providers.Programs that address depression and attention deficit/hyperactivity disorder (ADHD)are offered. These programs are evaluated based on surveys of participating membersCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 32
and calls received on the programs’ toll-free telephone information line (1-866-639-2943). Members may opt out of any Preventive Health program, if they wish, by calling1-866-639-2943.Community Care's toll-free Preventive Health Program information line (1-866-639-2943) provides member information about depression and attention deficit hyperactivitydisorder. Providers are encouraged to share this information with members.II.D.1 Provider Information and Preventive Behavioral Health Program:DepressionII.D.1a ImplementationDepression is the most common diagnosis among adults between the ages of 18 and64 among Community Care’s membership. Antidepressant medications are nowfrequently prescribed alone, or in combination, as a first-line treatment for depression.Many individuals also participate in psychotherapy for depression. For both of thesetreatment approaches, compliance issues and member behavior in relation to thetreatment can pose major barriers in an otherwise highly effective treatment regimen.Community Care views the role of educating members about the treatment process,helping them understand their experience of treatment, and encouraging them toassume an active role in their treatment as factors critical to ensuring effective treatmentand preventing relapse. This program helps members understand the course oftreatment, how treatment works, and what kind of effects they might anticipate. Theprogram emphasizes communication with providers and educates participants aboutself-care during treatment and recovery. Helping members understand their role in thetreatment process can have a positive impact on the treatment of depression, aiding intheir return to baseline levels of functioning at work and at home.II.D.1b GoalsThe goals of Community Care’s Preventive Health Program for depression are:To educate members about depression.To help members identify symptoms to track improvement over the course oftreatment.To educate members about how antidepressants work.To educate members about psychotherapy.To help members understand what they can expect from treatment.To help members anticipate the effects of antidepressant medications and the sideeffects they may encounter.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 33
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 and 24: I.E. Care Management Team“Advocat
Page 25 and 26: In order to serve special populatio
Page 27 and 28: Psychiatric Rehabilitation Clubhous
Page 29 and 30: always be considered in light of th
Page 31: Tell their provider everything they
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
Page 74 and 75: When such disclosure to health care
Page 76 and 77: Practitioners are informed of the r
Page 78 and 79: Medication(s) that have been prescr
Page 80 and 81: 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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