Billing Manual for Community Care Network Providers

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APPENDIX A.2. Confidentiality 130APPENDIX A.3. Supplemental Confidentiality 157APPENDIX A.4. Significant Member Incidents 198APPENDIX B.1. Consents for Release of Information Forms and forPhysical Health/Behavioral Health Collaboration 201APPENDIX C.1. Priority Populations 208APPENDIX D.1. Behavioral Health Managed Care Organizations (BH-MCOs)Performance/Outcome Management System (POMs) 211APPENDIX E.1. Companion Guide for Northeast Counties 216APPENDIX F.1. Companion Guide for North Central Counties 217Community Care Member Handbooks Can Be Assessed At:www.ccbh.com/healthchoices/memberhandbookCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 5
Page 6 and 7: such as seafood processing, forestr
Page 8 and 9: Guidelines for Obtaining Approval f
Page 10 and 11: PsychologicalTesting/Neuropsycholog
Page 12 and 13: Guidelines for Obtaining Approval f
Page 14 and 15: I. About Community Care Behavioral
Page 16 and 17: “A self-determined and holistic j
Page 18 and 19: High-quality culturally competent h
Page 20 and 21: I.C.2 MeasurementExplicit, well-def
Page 22 and 23: I.D.1 Procedures for Suspected Frau
Page 24 and 25: It is common for Community Care’s
Page 26 and 27: I.E.3 Pre-certification TeamCommuni
Page 28 and 29: II. About Community Care HealthChoi
Page 30 and 31: An open discussion of appropriate o
Page 32 and 33: II.C. Member SatisfactionMember sat
Page 34 and 35: To help members understand the impo
Page 36 and 37: If you have questions or concerns,
Page 38 and 39: ased on authorization and treatment
Page 40 and 41: First Level Complaint ProceduresMem
Page 42 and 43: the member or provider for more inf
Page 44 and 45: II.F. Member GrievancesCommunity Ca
Page 46 and 47: until the prescription runs out whi
Page 48: Determinations will be made within
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type of hearing, the location of th
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screening process prior to being of
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III.A.1 Practitioner Credentialing
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Provider Benchmarking (See Section
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III.B.2 Change in Facility informat
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III.B.5b Termination with CauseActi
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Community Care’s requirements for
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III.C.1c Transferring Confidential
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Coordination of care.Billing.Adjudi
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III.C.5 Member Access to Utilizatio
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The specific information to be rele
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this email in error, please notify
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When a member is discharged from an
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a benefits package. In those instan
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Providers are expected to report al
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Review claim reports compared to ag
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III.K. Provider EducationCommunity
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http://www.ccbh.com/providers/pheal
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Family Functional TherapyIndividual
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A behavioral health emergency is th
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IV.E.1 Community Care’s Expectati
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Billing Manual forCommunity Care Ne
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to whom you provide services is not
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Carbon/Monroe/Pike - 90 days, 180 d
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Providers have two options to submi
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Missing Quantity Institutional Clai
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11 Insured policy, Group or FECA Nu
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UB-04Listed below are instructions
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43 Description Not required44 HCPCS
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The primary payor’s EOP/EOB must
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Coordination of Benefits (COB) clai
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Provider Online Website:https://onl
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Authorization Rules: The definition
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Glossary of Terms and Abbreviations
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ICM: Intensive Case Management; a C
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AppendicesCommunity Care Provider M
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When a provider bills for the provi
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d. Each referral is unique and ther
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Findings will be reported to senior
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Another part of the “Statement of
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Member Identifiable Information. Co
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Diagnosis (es)Treatment DatesDate o
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Community Care has the right to den
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The member requesting information a
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Having established such a system, C
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This includes, but is not limited t
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HIPAA regulations.See the policy on
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such crime; and the identity, descr
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statute. Each practitioner is infor
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As described in Community Care’s
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If the member is denied the right t
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If the privacy officer determines t
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concerning the member and the like.
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agent, employee, or medical member
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Exception: Records concerning perso
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• All employees of a facility sha
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Care personnel with guidance concer
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• Workers compensation.• Inmate
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POLICYCommunity Care, our staff and
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A facility or group practice name,
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the intended recipient. If you beli
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In the event that Community Care wo
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collection, use, or disclosure of h
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The health plan may distribute the
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A member’s Right to Amend Protect
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If a member is granted access to re
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Community Care’s senior managemen
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164.504(e)(ii)(C)).He/She will ensu
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Many requests from employers for da
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must be maintained in a secure loca
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information needs to be amended.The
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If granted, Community Care will rel
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The individual receiving informatio
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APPENDIX B.1. Consents for Release
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(Date of signature)________________
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Authorization for the Release of Sp
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Sample Letter for Permission to Sha
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C. COEXISTING CONDITION OR CIRCUMST
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APPENDIX D.1. Behavioral Health Man
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Identifying indicators (including b
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contractor)• Increase appropriate
Page 217:
APPENDIX F.1. Companion Guide for N
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Billing Manual for Community Care Network Providers

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