Billing Manual for Community Care Network Providers

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IV.E.3 Transition of Care to another Community Care ProviderWhen a Community Care provider contract is terminated, Community Care may allowup to a 60 day transition of care period or through the acute phase of the disorder,whichever is less, for members under the terminated provider's care.IV.F. Care Management ServicesShould a member require other than routine outpatient services, he/she will be assignedto a care manager. The goals of Community Care’s care management program are to:Ensure members’ timely access to geographically convenient needed services.Ensure quality care at the least-restrictive, most cost-effective level.Ensure equitable access to care for members across the network, in the mostappropriate clinical setting and at the appropriate level of care.Ensure that care meets standards and quality criteria.Assess and correct for over utilization, under utilization, inefficiency, and delays inaccess to services.Ensure that services are culturally competent.Ensure that the member and family (if indicated) are involved in treatment planning.Ensure that behavioral health services result in positive outcomes for members.For routine outpatient services, the Community Care customer service representativewill ensure members’ timely access to geographically convenient services.Care Managers may not deny care. If a member’s behavioral health status does notmeet Medical Necessity Criteria for the level of care or the services do not meet ClinicalPractice Guidelines criteria, the service is reviewed by a Community Care professionaladvisor (peer reviewers).IV.F.2 Peer ReviewersCommunity Care contracts with board-certified psychiatrists and addiction specialists,some with subspecialty expertise in providing child and adolescent or geriatric care andwith state-licensed psychologists to serve as peer reviewers. Peer reviewers arethoroughly trained to evaluate whether proposed services meet quality criteria, MedicalNecessity Criteria, and Clinical Practice Guidelines criteria. Community Care peerreviewers perform the following services: Render objective decisions on the level of care (Medical Necessity) and theappropriateness and quality of care. Advise Community Care’s Chief Medical Officer and Quality Management and CareManagement Departments. Consult with providers on precertification and concurrent and post-service reviews.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 96
Billing Manual forCommunity Care NetworkProvidersOriginal Claims Mailing Address:Community Care Behavioral Health OrganizationP.O. Box 2972Pittsburgh, PA 15230Corrected Claims Mailing Address:Community Care Behavioral Health OrganizationAttention: Claim CorrectionsOne Chatham Center, Suite 700112 Washington PlacePittsburgh, Pennsylvania 15219Provider Line: 1-888-251-CCBH (2224)Website: www.ccbh.comCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 97
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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
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II.D.3 Providers’ Role in the Pre
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Community Care has a total of 30 ca
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Department of Health and provide in
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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
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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
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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 90 and 91: If you, as a Community Care provide
Page 92 and 93: When the precertification is for se
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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
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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
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Page 120 and 121: Community Care Procedure Code: The
Page 122 and 123: C/FST: Consumer/Family Satisfaction
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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
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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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