Billing Manual for Community Care Network Providers

III.K. Provider EducationCommunity Care offers provider training on a variety of topics, with a focus ondeveloping skills in managing care, meeting and exceeding performance standards, andensuring cultural competence in delivery of behavioral healthcare services throughoutthe network. The person who will receive mailings about these sessions is thedesignated contact person identified in your network application. Please check with yourCommunity Care provider relations representative for the name of this person or if youneed to change the contact person (key contact).III.L. Provider Advisory CommitteeAll Community Care providers are eligible, welcome, and urged to participate in theCommunity Care Provider Advisory Committee in their local area. These committeesare designed to allow providers to give feedback to Community Care on a regular basis.There are other Community Care committees that include providers. If you would like toparticipate, please call the Community Care Provider Line (1-888-251-2224).IV. Providing Services to HealthChoices Network MembersCommunity Care has developed specific procedures for providers to follow in providingbehavioral health services to HealthChoices members. These procedures: Verify that the services are covered. Ensure that every member receives the level of care that he/she requires. Provide member services in a seamless fashion. Ensure that care meets quality standards.The following sections detail procedures for providing services. As a part of CommunityCare's commitment to quality improvement, these procedures are updated as needed.A. Verifying Member Eligibility for HealthChoices Network ServicesB. Medical Necessity (Level of Care) CriteriaC. Obtaining Authorizations (Registration, Precertification)D. Standards for Member Access to Services (Appointments)E. Coordination of Care, Referrals, Transition of Care to Other ProvidersF. Care Management ServicesIn addition, Community Care has a policy to review proposed new treatments forbehavioral health disorders. To submit a new technology request for review, talk with aCommunity Care care manager. The care manager will forward your request toCommunity Care's Chief Medical Officer for review.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 87