Provider Manual
TABLE OF CONTENTS
- Child and Adolescent Strengths Based Evaluation (CCASBE-LD)
- Confidentiality
- Drug and Alcohol Services
- Grievance Process
- Information Required for Service Authorization
(Documentation Guidelines for Inpatient, Documentation Guidelines for Continued Stay Reviews, Documentation Guidelines for Discharge) - Inpatient and Alternative Levels of Care
- Medical Necessity Criteria
- Outpatient Services (Mental Health and D&A)
- Peer Review Process
- Prevention, Education and Outreach
- Priority Populations
- Purpose and Scope
- Records Retention
- Requests for Authorizations/Retro-authorizations
- Service Authorization Procedures
- Special Procedures
(Electro-Convulsive Therapy, Psychological Testing and Methadone Services) - Utilization Management Staff
- Advance Directives
- Americans with Disabilities Act (ADA)
- Appendix AA
- Appendix H
- Assessments / Evaluations
- BHRS Reporting Requirements
- TSS Schedule Process
- Compliance with Quality Improvement and Utilization Management Programs
- Confidentiality
- Coordination of Care
- Cultural Competence
- Functional Behavioral Assessment Requirements
- Member Right to Continuing Course of Treatment
- Member's Right to File a Complaint, Grievance or DPW Fair Hearing
- Member's Rights and Responsibilities
- National Provider Identifier (NPI)
- Notification of Change in Access to Services
- Notification of Change in Practice Status
- Notifying Members of Authorized Services
- Obligation to Report / Duty to Warn
- POMS Initial Consumer Registration
- POMS Quarterly Status Update
- Professional Standards
- Prohibition of Member Billing
- Reporting Adverse / Critical Incidents
- Site Visits
- Treatment Record Reviews
- Treatment Record Standards
- Administrative Complaints
- Credentialing and Recredentialing
- Fair Hearing Process
- National Credentialing Committee (NCC)
- Network Management Functions
- Non-renewal of Provider Agreement
- Practitioner and Facility Agreements
- Provider Appeals Related to Credentialing, Sanctions or Termination
- Provider Contracting
- Provider Recruitment
- Provider Sanctions
- Provider Training
- Assistance with Claims Questions
- Claim Filing Requirements
- Claims Adjustments
- Claims Submission
- Fraud and Abuse
- Going Online with ValueOptions
- Online Services Account Request Form
- Online Services Intermediary Authorization Form
- Prohibition of "Balance Billing"
- Summary Voucher / Electronic Remittance Advice (ERA)
- Third Party Liability (TPL)
- Confidentiality
- Organizational Structure, Roles and Responsibilities
- Purpose and Scope
- Quality Management Activities
- Quality Management Work Plan
- Work Plan Evaluation and Update Process
Appendix A: Glossary of Terms
