Billing Manual for Community Care Network Providers

ORA member expresses a readiness for, or amenability to, treatment if initiated within a24-hour period,Access to care for urgent behavioral health conditions must be provided within24 hours.IV.D.3 Routine Outpatient ServicesA routine outpatient service exists if the member exhibits signs or symptoms of a mentalillness or substance use disorder that indicate the need for assessment and/ortreatment without evidence of imminent or impending risk to the member or others or ofan acute, significant change in level of functioning.Access to routine services must be provided within seven days.The member may directly schedule an appointment with the provider, who will useMedical Necessity Criteria to determine the level of service that is needed and willcomplete registration with Community Care within 72 hours (with a grace period up to30 days) of the initial outpatient visit or request precertification, depending on theproposed treatment plan.If the member contacts Community Care directly, a care manager or customer servicerepresentative will help the member find an available appointment in the required timeframe.If the member prefers an alternative appointment time that falls beyond the prescribedtimeframe, the provider should document this in the provider’s appointment records.As part of Community Care's outreach efforts, we may contact a provider or a memberto ensure that certain appointments, such as ambulatory follow up appointments afterinpatient care, are kept.IV.E. Coordination of Care, Referrals, Transition of Care to Other ProvidersA member can only receive safe, comprehensive health care when all providers ofservices communicate and work together to educate and encourage the member tocomply with treatments and participate in available prevention programs. For a samplecoordination of care template and sample release of information forms, please seeAppendix B.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 94