Billing Manual for Community Care Network Providers

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the implementation and application of Community Care’s confidentiality policies andprocedures.Highlights of this department’s responsibilities include the following:At least annually, the department and privacy officer will evaluate ways to (1) reducethe collection of member identifiable data and information and (2) aggregate or deidentifysuch data and information as close to the collection point as possible, asidentified by surveying Community Care representatives, holding brainstormingsessions with Community Care representatives and evaluating complaints.The privacy officer is responsible for reviewing and approving information given tomembers, including information about Community Care’s confidentiality policies andprocedures.Community Care has identified circumstances necessitating special protection ofmember identifiable data and information and these are described in the policy andprocedure “Handling of Member Identifiable Information.” Requests for specialprotection of member identifiable information are referred to the privacy officer, whowill consider the request, determine whether it should be honored and notify therequestor of the decision. If the request is honored, the privacy officer will determinethe mechanism to adhere to the request and update the procedure “InternalHandling of Member Identifiable Information” to reflect the addition. If the privacyofficer determines not to honor the request, the requestor will be notified of his or herright to appeal the decision through Community Care’s appeals process.All member and provider concerns regarding confidentiality shall be logged ascomplaints and processed through Community Care’s complaint and appealsprocess.The privacy officer along with the Chief Medical Officer, reviews requests for accessto member identifiable data and information from all sources, internal and external.In determining the timeframe in which to conduct the review, the Chief MedicalOfficer will consider the potential benefit to members of allowing requested access todata and information. When deciding whether or not to honor the request for accessto such data and information, the Chief Medical Officer will weigh the potentialbenefit and risks to members.The Chief Medical Officer is responsible for reviewing all requests for access toconfidential data and information for research purposes.III.C.2 Collecting and Using Member identifiable InformationCommunity Care collects and uses member identifiable data and information routinely inthe performance of its work. Purposes for which data and information are routinelycollected include:Verification of member eligibility for services.Management of behavioral health benefits, including prospective, concurrent, andretrospective reviews and decisions regarding coverage for requested treatment.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 70
Coordination of care.Billing.Adjudication of claims.Performance measurement and improvement (“quality assurance”).Compliance audits.Prevention and disease management activities.Provider credentialing.Investigating and resolving inquiries and complaints.Processing appeals.Complying with regulatory requirements and accreditation standards.Community Care is responsible for notifying members of Community Care’s routinecollection and use of member identifiable data and information for the purposes justdescribed. The use of member identifiable information for purposes other than thoselisted requires written authorization from the member or representative, unless use ofthe information is permitted or required by applicable law or a valid court order.III.C.3 Informing Members about ConfidentialityCommunity Care prepares information for members that describes Community Care’sconfidentiality policies and procedures. This information covers key points of theinformation contained in Community Care’s Confidentiality Policy, such as:Collecting and Using member identifiable Information.Handling of member identifiable Information.Ability to give informed authorization.Member access to utilization records.Disclosure of information.An accounting of disclosure of member protected health information (PHI) tomembers.Amending PHI by the member.Information about confidentiality is disseminated to members in:Member “Rights and Responsibilities.”Member instructions on how to obtain care, appeal a coverage decision, and accesscustomer services support.The member complaint process.Information about confidentiality is sent to members annually via member newslettersand in the Member Handbook. Community Care’s Notice of Privacy is also posted onour website at http://www.ccbh.com/privacy.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 71
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APPENDIX A.2. Confidentiality 130AP
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Clinical Fax by County:Adams 1-866-
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Outpatient Therapy 1MD OutpatientMe
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Functional Familytherapy (FFT)Multi
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Non-Acute PartialHospitalizationNot
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I.A. Code of EthicsCommunity Care
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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 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 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
Page 86 and 87: dialogue and intervention may occur
Page 88 and 89: For any questions about providing s
Page 90 and 91: If you, as a Community Care provide
Page 92 and 93: When the precertification is for se
Page 94 and 95: ORA member expresses a readiness fo
Page 96 and 97: IV.E.3 Transition of Care to anothe
Page 98 and 99: Billing ManualCommunity Care Behavi
Page 100 and 101: Even though an authorization may be
Page 102 and 103: Timely File requests are to be mail
Page 104 and 105: Provide an alternative to the use o
Page 106 and 107: Required Claim FieldsIn the followi
Page 108 and 109: 24C EMG Not required24D Procedure C
Page 110 and 111: 17 Discharge Status Required forINP
Page 112 and 113: 67a-q Diag. Code Required68 Unlabel
Page 114 and 115: • Explanation of Benefits (EOB) i
Page 116 and 117: Many of the services covered by Com
Page 118 and 119: 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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