NBH Partnership Provider Handbook Supplement

The ValueOptions^® Colorado Medicaid Provider Handbook serves as a supplement to the ValueOptions^® Participating Provider Handbook and provides a quick reference guide about policies and procedures specifically related to NBH Partnership.

Introduction

• Welcome
• General Information
• Colorado Medicaid BHOs

Continuum of Services

• Clinical Services Descriptions

Provider Assistance & Referrals

• Clinical Operations
• Customer Service Department
• Network Credentialing
• Tele-Connect and ProviderConnect
• Provider Availability and Access to Care Standards
  
  Referrals
  
  How Clients Access Behavioral Health Care

Utilization Management Procedures

• Overview
• Care Management Functions
• Authorizations
• Medical Record Requirements
• Advanced Directives
• Psychological Testing Evaluation Form – Click Here

Client Choice of Providers

• Member Choice

Second Opinion

• Second Opinions in a Disagreement with Treating Provider
• Second Opinions in a Disagreement with a Notice of Action

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

• Case Managers
• Care Providers
• How to Access EPSDT Services

Coordination of Care

• Provider Responsibilities
• Getting Member’s a PCP
• Coordination with Other Agencies

Reviews, Reconsiderations and Appeals

• Contacting Member and Family Affairs for Assistance
• Clinical Guidelines
• Peer Reviews
• Requesting Reconsideration
• Retrospective Authorization Process
• Member’s Request for Appeal of an Action
• Member’s Request for a State Fair Hearing
• Continuing Services
• Definitions
• DCR (Designated Client Representative) Form

Network Credentialing

• Credentialing and Recredentialing Standards
• Contract Requirements
• Credentialing Committees
• Termination, Sanctions and Appeals
• Change of address form – Click Here

Benefits Summary

• Colorado Medicaid Exclusions
• Benefit Limites

Colorado Client Assessment Client Record (CCAR)

• CCAR Requirements
• CCAR Form Example
• CCAR Website Link  - Click Here

Billing for Services

• Billing for Services
• Electronic Claims Submission
• Claims Appeals
  
  Colorado Medicaid Adjustment Form – Click Here
  
  Covered Diagnoses – Click Here

Quality Improvement

• Program Integrity
• Adverse Incidents
• Provider Quality Improvement Program
• Quality of Care
• Treatment Record Audits
• Confidentiality
  
  Adverse Incident Form – Click Here

Office of Consumer and Family Affairs

• General Information
• Member and Family Input
• Cultural Competency
• Grievances and Appeals of Actions
• Compliments
  
  Ombudsman Flier in English – Click Here
  
  Ombudsman Flier in Spanish – Click Here
  
  Member Rights Poster – Click Here

Transportation

• Making Transportation Arrangements

NBHP Specific Contract Requirements (Coming Soon)

Community Mental Health Center Sites 

Documentation Standards

• General Requirements
• Service/Treatment Plans
• Progress Notes

Treatment Systems Level of Care and Diagnosis-Based Treatment Guidelines

• Level of Care Guidelines
• Diagnosis Based Treatment Guidelines
• Treatment Technologies

Sample Clinical Forms

• Clinical Forms – Click Here