Billing Manual for Community Care Network Providers

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If you, as a Community Care provider, are contracted to perform outpatient mentalhealth services for members, you may be authorized to perform a specific service for aspecific member by registering with Community Care, as described below.Outpatient Registration is intended to assist providers by:Decreasing administrative work.Reducing overhead costs.Improving availability and access to outpatient services.Eliminating service delays caused by waiting for authorization of outpatient services.Encouraging providers to manage outpatient treatment services.Eliminating the need for continued stay treatment plans.Easing billing process.Enhancing the quality of service delivered to members.Allowing clinicians to focus on service delivery.The Outpatient Registration (OPR) Form is used to register members for initialoutpatient services. Forms can be ordered by calling the Provider Line at 1-888-251-2224 or contacting your assigned provider representative. OPR Forms are availableonly to contracted providers registered with the state as:PsychiatristsPsychologistsFQHCOutpatient Drug and AlcoholOutpatient Mental HealthOther - Outpatient onlySee APPENDIX D for Performance Outcomes Management System (POMS)information.IV.C.2 Precertification/Preapproval Authorization Procedures *Providers must obtain precertification/preapproval before providing the followingservices to members:Mental Health ServicesAcute Partial HospitalizationBehavioral Health Rehabilitative Services (BHRS)Community Treatment Teams (CTT)/ Adult Assertive Community Treatment (ACT)Diversion and Acute Stabilization/RespiteElectroconvulsive TherapyFamily Based Mental Health Services (FBMHS)Family-Focused Solution BasedCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 90
Family Functional TherapyIndividualized Residential Treatment/CRRInpatient HospitalizationMobile Mental Health Therapy (MMHT)Multisystemic Therapy (MST)Multidimensional Treatment Foster Care (MTFC)Psychiatric RehabilitationPsychiatric Rehabilitation ClubhousePsychological/ Neuropsychological TestingResidential Treatment Facilities (RTF)School-Based Partial Hospitalization ProgramSummer Therapeutic Activities ProgramChemical Dependency ServicesHalfway House 2BAcute Partial Hospitalization ProgramPartial (sleepover) Hospitalization ProgramMedically Managed Rehabilitation (hospital-based) 4BMedically Monitored Rehabilitation (short-term, non-hospital) 3BMedically Monitored Rehabilitation (long-term, non-hospital) 3CMedically Managed Detoxification (hospital-based) 4AMedically Monitored Detoxification (non-hospital) 3ATo obtain precertification/preapproval authorization for these services for a member, callthe Community Care Provider Line 1-888-251-2224 24 hours a day/seven days a weekto review Medical Necessity Criteria with a care manager. If approved, an authorizationnumber will be generated for a certain time frame and number of units of service. Whenrequesting inpatient care, the Community Care precertification team staff will takeclinical information from behavioral health professionals. The provider will be given a“good faith authorization” if it appears the member will meet Medical Necessity Criteriafor an admission, with the number of days to be authorized. If it appears that MedicalNecessity Criteria are not met, the behavioral health professional will be informed of thisissue.The actual authorization will not be provided until the member has arrived at theaccepting hospital or facility and a physician has accepted the member for admission,unless the member is being transported by ambulance. If Medical Necessity Criteria arenot met, a Community Care professional advisor will be consulted.Precertification information can be provided by behavioral health professionals only.Other social services staff such as CYF, foster care, and school personnel will beadvised to take the member to an admitting facility, a nearby Emergency Department, ora crisis service for evaluation.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 91
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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
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In order to serve special populatio
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Psychiatric Rehabilitation Clubhous
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always be considered in light of th
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Tell their provider everything they
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and calls received on the programs
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II.D.1e EvaluationIndividuals parti
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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
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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 76 and 77: Practitioners are informed of the r
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Page 80 and 81: III.E. Clinical Practice Guidelines
Page 82 and 83: Community Care has developed a plan
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Page 88 and 89: For any questions about providing s
Page 92 and 93: When the precertification is for se
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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
Page 126 and 127: APPENDICESAPPENDIX A.1. Fraud, Wast
Page 128 and 129: . The provider will also receive a
Page 130 and 131: APPENDIX A.2. ConfidentialityPOLICY
Page 132 and 133: A Facility or group practice name,
Page 134 and 135: Confidential data and information s
Page 136 and 137: The medical director or his/her des
Page 138 and 139: 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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