Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
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IV.E.1 <strong>Community</strong> <strong>Care</strong>’s Expectations <strong>for</strong> Exchange of In<strong>for</strong>mation with Primary<strong>Care</strong> Physicians and within the Behavioral Health Continuum to FacilitateContinuity and Coordination of <strong>Care</strong>Coordination of <strong>Care</strong> with the member's primary care physician (PCP) or otherbehavioral health provider is always expected and particularly important when themember is prescribed a medication or treatment that may have an impact on themember's health or interact with medication or treatment prescribed by the PCP orpsychiatrist.Members <strong>for</strong> whom coordination of care is indicated include (but are not limited to):Those with chronic or serious medical illness.Those with a newly prescribed a psychotropic medication and who have been takingmedication <strong>for</strong> a medical condition.Those requiring multiple medications to treat serious and persistent mental illness.Those receiving medication with a history of medication compliance problems.Pregnant women who require medication to manage a behavioral health condition.Those with a substance abuse problem prescribed medication <strong>for</strong> a physical orbehavioral health problem, especially when the medication may be habituating.To promote needed communication with the PCP or other behavioral health provider,<strong>Community</strong> <strong>Care</strong> requires that you, the provider, tell each member about the importanceof involving his or her PCP or other behavioral health provider. <strong>Community</strong> <strong>Care</strong> alsoexpects that you will follow up with the PCP or other behavioral health provider. Youmust obtain the member’s written authorization to initiate communication. <strong>Providers</strong> arealso expected to take a holistic approach to promote the importance of the integration ofthe PHMCO services as a part of the member’s comprehensive recovery plan whenapplicable.Exchange of In<strong>for</strong>mation with the PCP, PHMCO, and other behavioral health specialistsis monitored on a routine basis from record review data. Results are made available toproviders via the Provider Line or <strong>Community</strong> <strong>Care</strong>’s website.IV.E.2 Referrals <strong>for</strong> Other Behavioral Health ServicesWhen you determine that a member requires behavioral health services that are notwithin the scope of your practice, call the Provider Line (1-888-251-2224) and ask acare manager <strong>for</strong> help in identifying <strong>Community</strong> <strong>Care</strong> contracted providers who canprovide those services.<strong>Community</strong> <strong>Care</strong> Provider <strong>Manual</strong> | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 95