Billing Manual for Community Care Network Providers

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If you have questions or concerns, or would like to discuss the program, please contactus at 1-866-639-2943.II.D.2 Provider Information and Preventive Behavioral Health Program:Attention Deficit Hyperactivity Disorder – Your Child and YouCommunity Care offers a preventive health program for parents/guardians of childrenwho are being assessed for, or have been diagnosed with, Attention DeficitHyperactivity Disorder (ADHD). This program is designed to improve clinical outcomesfor both children and their parents/guardians by educating them about the disorder andhow to work more effectively with their children.This educational program complements the care that you provide. Together with yoursupport, Community Care can help parents/guardians recognize the effect of ADHD ontheir lives and the lives of their children. This program can help teach parents/guardiansto take active steps to foster communication, help modify problem behaviors in thehome and reduce the distress, which they and other family members may experience incaring for a child with ADHD.Information about the program follows along with a description of what you can do toassist us in this important preventive health initiative—which we believe will have apositive benefit for the children in your care.II.D.2a ImplementationAttention deficit and disruptive behavior disorders are among the top diagnoses forchildren (ages 0-12 years) whose behavioral health care is managed by CommunityCare. Care for children with ADHD extends beyond medication management andbehavioral therapy with the child. Important to helping children with ADHD is thedevelopment of a family environment in which the child can prosper and feel supported.In treating a child with ADHD, the role of the parents/guardians in helping their child iscritical. This program helps parents/guardians learn how they can shape their child'sbehaviors and how they can provide an emotionally supportive and productiveenvironment for their child with ADHD. Parenting a child with ADHD can be anexhausting and frustrating experience, often leaving parents/guardians feeling helplessand without support or understanding. Parents/guardians may be strained or unable tomeet the special demands which parenting a child with ADHD requires. Empoweringparents/guardians through education and training can be an effective way to help themlearn to cope. Teaching parents/guardians skills, which translate into parentingapproaches appropriate to the unique needs of children with ADHD, can help restore asense of capability and confidence for parents/guardians and can help their childbecome more focused and productive.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 36
II.D.2b GoalsThe goals of Community Care’s Preventive Health program for Attention DeficitHyperactivity Disorder (ADHD) are:To educate parents/guardians about ADHD.To help parents/guardians develop more effective ways of relating, rewarding, anddisciplining their children.To help parents/guardians cope with the emotional toll that can accompanyparenting a child with ADHD.II.D.2c Criteria for Member InclusionThis program is directed to parents/guardians of children age 12 and younger who havebeen diagnosed with Attention Deficit Hyperactivity Disorder (DSM-IV codes 314.00;314.01 and 314.9) as a primary or secondary Axis I diagnosis.II.D.2d InterventionsThis program consists of several educational modules, which are mailed toparents/guardians of children who have recently received authorization for evaluation ortreatment of ADHD. All three newsletters are available on Community Care’s website athttp://www.ccbh.com/providers/memberhelp/preventivehealth.The first module helps educate parents/guardians about ADHD and suggests ways inwhich they might begin to assess how ADHD affects their child's life. The first modulealso includes an ADHD medication fact sheet to complement information that they arealready receiving from their doctor.The second module educates parents/guardians about effective ways to think abouttheir child's experience. It teaches parents/guardians how to communicate with theirchild and how to use structure, reinforcements, and discipline in an optimal way. Finally,because parenting a child with ADHD can be difficult and stressful, the third and lastmodule addresses ways parents/guardians can take better care of themselves bysuggesting ways they can creatively cope with the stress they may experience.II.D.2e AvailabilityAt least annually, Community Care informs our members about this preventivebehavioral health program. This information is communicated to members throughnewsletters and 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. Parents/guardians of children who meet diagnostic eligibility criteriaCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 37
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 34: and calls received on the programs
Page 35: II.D.1e EvaluationIndividuals parti
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
Page 84 and 85: 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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Billing Manual for Community Care Network Providers

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