Billing Manual for Community Care Network Providers

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Practitioners are informed of the right to review information in their file through thecover letter in the application packages for credentialing/recredentialing orassessment/reassessment.Practitioners may obtain a copy of their file by making the request in writing.Credentialing staff will send a copy of the practitioner’s file, marked “Confidential,” tothe practitioner within 10 business days of receipt of the written request for the file.NPDB information and peer review (peer reviewer) information is not included in thefile sent to the practitioner.Practitioners are notified by Credentialing staff of any information obtained duringcredentialing/recredentialing or assessment/reassessment activities that variessubstantially from the information provided by the Practitioner.Practitioners have the right to correct erroneous information by submitting corrections inwriting or sending additional documents to the Credentialing Department. Credentialingstaff document the verbal information or corrections provided by the practitioner,including the date and signature of the individual obtaining the information.III.C.8 Provider ConfidentialityCommunity Care providers are responsible for maintaining confidentiality in thecollection, use, and disclosure of member identifiable information. Requirements are asfollows:Member identifiable data and information (such as medical records, appointmentbooks, correspondence, laboratory results, billing records and treatment plans),whether paper-based or on removable electronic data storage media, must bemaintained under lock and key, either in locked cabinets or in a locked area. Thedata storage area must be separate from public areas such as waiting rooms, areaswhere services are delivered and any other areas accessible to unauthorizedpersons. When unlocked, paper records and removable computer storage mediamust be maintained in a secure location where they are not accessible and theircontent is not visible to unauthorized individuals.When computers are used to store member identifiable information, they must bepassword-protected (unless all persons at the site are authorized access and thecomputers are in secure locations not accessible to unauthorized individuals).Computer monitors must be positioned such that they are not visible to unauthorizedindividuals.If electronic mail (email) is used to transmit member identifiable data or information,the email must be flagged as confidential and a confidentiality notice must beprominently displayed at the beginning of the email that conveys a messagesubstantively similar to the following: “This email contains confidential and privilegedinformation for use only by the intended recipient. Do not read, copy, or disseminatethis material unless you are the intended recipient. If you believe you have receivedCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 76
this email in error, please notify the sender by return email, securely delete this fileand any electronic or magnetic copies and destroy any paper copies.”Telefacsimile (fax) machines must be located where faxes may not be intercepted orviewed by individuals not authorized to access member identifiable information.When member identifiable information is transmitted by fax, a confidentiality noticesimilar to the following must be prominently displayed on the cover sheet: “Thisfacsimile transmission contains confidential and privileged information for use onlyby the intended recipient. Do not read, copy, or disseminate this material unless youare the intended recipient. If you believe you have received this message in error,please notify the sender by facsimile or telephone and destroy this document.”Please call the Provider Line (1-888-251-2224) for any authorization for release ofinformation forms that might be needed in the care of members.III.D. Record Keeping StandardsCommunity Care has established treatment record documentation guidelines,performance goals, and standards for availability of treatment records to facilitateaccurate record keeping, communication between practitioners and coordination andcontinuity of care within the behavioral health continuum and the medical deliverysystem. Community Care expects providers to implement these treatment recorddocumentation guidelines.Each member’s medical record must meet the following standards:The member address, employer or school, home and work telephone numbers,emergency contacts, marital/legal status, authorization forms, and guardianshipinformation is documented, as relevant.The member's name or identification number is present on each page.The responsible clinician's name and professional degree are documented.All entries are dated.The record is legible.Relevant medical conditions are listed, prominently identified, and updated.Presenting problems and relevant psychological and social conditions affecting themember's medical and psychiatric status are documented.Special status situations such as imminent risk of harm, suicidal ideation, orelopement potential are prominently noted, documented, and updated in compliancewith written protocols.Past medical and psychiatric history is documented, including previous treatmentdates, provider information, therapeutic interventions and responses, sources ofclinical data, relevant family information, results of laboratory tests, and consultationreports.Allergies and adverse reactions are clearly documented.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 77
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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
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Confidentiality policies including
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Within 30 minutes for urban areas.W
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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 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 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
Page 120 and 121: Community Care Procedure Code: The
Page 122 and 123: C/FST: Consumer/Family Satisfaction
Page 124 and 125: 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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