Billing Manual for Community Care Network Providers

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To help members understand the importance of participation in and compliance withpsychotherapy.To encourage members to communicate with their providers about their treatment.To instruct members in ways they can improve their recovery from depression.II.D.1c Criteria for Member InclusionThis program is designed for members ages 18 and over who have been diagnosedwith a depressive disorder (DSM-IV codes: 296.20-296.36, 300.4 and 311) as a primaryor secondary Axis I diagnosis and who have been prescribed antidepressantmedications and/or are being treated with psychotherapy. This program is not intendedfor individuals who have been diagnosed with bipolar disorders and other mooddisorders not indicated by the codes listed above.II.D.1d InterventionsThis program consists of three educational newsletters, which are mailed to memberswho recently received authorization for medication management and/or psychotherapyand for whom authorization data indicate a diagnosis of a depressive disorder. Copiesof all three newsletters are available on Community Care’s website athttp://www.ccbh.com/providers/memberhelp/preventivehealth.We encourage you to review them.The first newsletter focuses on basic information about depression and helps individualsto identify symptoms that they are experiencing. This information is designed to helpparticipants develop a vocabulary to discuss or describe their feelings and any changesin symptoms during their treatment. This module also introduces members to importantaspects of their care—types of psychotherapy treatment approaches, how theirmedication was chosen and basic information about side effects.The second newsletter emphasizes ways in which members can make the most of theirtreatment. This includes further information about medications including a discussion ofthe symptoms, which are most responsive to antidepressants, common side effects thatthey may experience, and how they can work with their provider to balance the positiveand negative effects of their medications. Similarly, members are provided informationabout how to optimize their psychotherapy treatment. In this regard, the newsletteraddresses several components of the psychotherapy process critical to effectivetreatment. Finally, self-care issues relevant to making changes outside of treatment,which can facilitate symptom remission, are introduced.The third newsletter educates members about the process of recovery from depression,treatment continuation and maintenance. It also elaborates on self-care issuesimportant in recovering and maintaining improvement after treatment.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 34
II.D.1e EvaluationIndividuals participating in the program are mailed (with a postage paid envelope) abrief survey assessing their perceptions of the usefulness of this program. Follow upphone calls are made to those members who choose to provide contact information.Over time, additional evaluation strategies may be added such as asking participatingmembers to complete a medication compliance inventory or tracking data on treatmentcontinuation or losses to follow-up using Community Care’s claims data.II.D.1f Availability to MembersAt least annually, Community Care informs our members about this preventivebehavioral health program. This information is communicated to members throughnewsletters or the Community Care website athttp://www.ccbh.com/healthchoices/preventiveprograms.Members are encouraged to take advantage of the program and are told how to obtainthe materials. Members who meet diagnostic eligibility criteria based on authorizationand treatment plan data automatically receive an introductory letter describing theprogram and information on how to opt out of the program if they desire.The educational modules described above are mailed out to participating members.Following the introductory letter, newsletters are mailed out at four-week intervals. Ifmembers choose not to participate in the program or wish to have the newsletters sentto a different address, they can call the toll-free preventive health program number (1-866-639-2943).II.D.1g What Providers Can DoCommunity Care’s prevention program is designed to increase the members’awareness of the important role they play in the effective treatment of their depression.Your support of this program is important to us. While Community Care contactsmembers automatically through the identification processes described above, you areencouraged to inform members about this program and call us with the name of anymember who meets the inclusion criteria.Participating members may seek additional information from you or have questionsregarding the issues discussed in the educational materials. We hope this will positivelyinfluence your treatment relationship and assist you in caring for our members.The Provider and Member materials are included on Community Care’s website at thelinks above. If you do not have access to the Internet please call toll-free 1-866-639-2943 and we will send the information to you. Please take the time to read thesematerials and give us your feedback. It is our hope that you find these materials avaluable addition to the care you provide.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 35
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 and 32: Tell their provider everything they
Page 33: and calls received on the programs
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
Page 82 and 83: 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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