Billing Manual for Community Care Network Providers

IV.E.1 Community Care’s Expectations for Exchange of Information with PrimaryCare Physicians and within the Behavioral Health Continuum to FacilitateContinuity and Coordination of CareCoordination of Care 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 for 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 for 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 for a physical orbehavioral health problem, especially when the medication may be habituating.To promote needed communication with the PCP or other behavioral health provider,Community Care requires that you, the provider, tell each member about the importanceof involving his or her PCP or other behavioral health provider. Community Care alsoexpects that you will follow up with the PCP or other behavioral health provider. Youmust obtain the member’s written authorization to initiate communication. Providers 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 Information 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 Community Care’s website.IV.E.2 Referrals for 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 for help in identifying Community Care contracted providers who canprovide those services.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 95