Billing Manual for Community Care Network Providers

Provider Benchmarking (See Section III.I) including analyses of member complaints,Significant Member Incidents, and quality and/or compliance audits.All practitioners must be recredentialed before their expiration date. Failure to berecredentialed before the expiration date will result in termination of thepractitioner’s contract with Community Care and will prevent payment for anyservices provided after the expiration date.A practitioner whose credentials with Community Care have expired cannot beauthorized or paid for services provided after the expiration date. Because verifyingcredentials with primary sources requires a minimum of seven weeks and may take upto six months, Community Care's Credentialing Department sends applications forrecredentialing before each practitioner’s deadline. Practitioners are urged to start therecredentialing process as soon as the application is received. The CredentialingDepartment will remind practitioners periodically of application components that remainincomplete.III.B. Facility/Organization Assessment, Contracting, ReassessmentAssessment of a Facility (hospital, residential treatment facility, community mentalhealth center, clinic, partial hospitalization program, or any other organization providingbehavioral healthcare services in a community setting) is the first step in CommunityCare's quality management process to ensure that members receive high-quality,responsive and culturally competent care. A facility must complete this process in orderto be eligible to contract to provide services to Community Care members. Assessmentincludes evaluations of the facility (such as licensing) and the site where services are tobe provided. Community Care ensures that facilities initially meet and continue to meetCommunity Care’s criteria and standards for participation in the network. CommunityCare assesses facilities upon initial application and thereafter at least every three years.III.B.1 Facility/Organization AssessmentA facility is considered to have completed its assessment on the date the CredentialingSupervisor and Chief Medical Officer or designee reviews the candidate's completedapplication, verifies that all criteria have been met and signs the Facility AssessmentForm.The Facility assessment process involves four major steps:Credentialing staff confirms the facility’s licensure and facility’s accreditation, if any,and status or standing of the facility with state regulatory bodies.Each location where the facility will offer services to Community Care members must"pass" a site visit unless the facility is accredited by the Joint Commission onCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 61