Provider Policy Manual

Providers-A

Health Choice Integrated Care Provider Policy Manual

HCIC Provider Policy Manual Crosswalk

Chapter 1  Introduction to Health Choice Integrated Care

Chapter 2 Network Provider/Service Delivery Requirements

                2.1 Appointment Standards and Timeliness of Service

                2.2 Referral and Intake Process

                2.3 Outreach, Engagement, Re-engagement and Closure

                2.4 Assessment and Service Planning

                2.5 SMI Eligibility Determination (UPDATE! February 2017)

                2.6 General and Informed Consent

                2.7 Pharmacy Management

                2.8 Pre-petition Screening, Court-ordered Evaluation, and Court-ordered Treatment

                2.9 Special Populations

                2.10 Crisis Intervention Services

                2.11 Housing for Individuals Determined to Have Serious Mental Illness (SMI)

                2.12 Special Assistance for Persons Determined to Have a Serious Mental Illness (UPDATE! March 2017)

                2.13 Arizona State Hospital

Chapter 3 Provider Responsibilities

                 3.1 Provider Deliverables

Chapter 4 Covered Services

                  4.1 Maternity and Medically Necessary Pregnancy Terminations (UPDATE! January 2017)

                  4.2 Family Planning (UPDATE! January 2017)

                  4.3 Dental and Vision Services (UPDATE! January 2017)

                   4.4 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program (UPDATE! January 2017)

Chapter 5 Communication and Member Information

Chapter 6 Network Requirements

                    6.1 Credentialing and Recredentialing Application Process

                    6.2 Material Changes

                    6.3 Training Requirements

                    6.4.1 Peer/Recovery Support Training, Certification and Supervision Requirements (UPDATE! February 2017)

                    6.4.2 Parent and Family Support Training, Certification and Supervision Requirements

                    6.5 Cultural Competency

                    6.6 Out of State Placements

                    6.7 Family and Youth Involvement in the Children’s Behavioral Health System

                    6.8 Use of Telemedicine

Chapter 7 Submitting Claims and Encounters

Chapter 8 Copayments and Other Member Fees

Chapter 9 Third Party Liability and Coordination of Benefits

Chapter 10 Covered Services Requirements

                   10.1 Medical Record Standards

 Chapter 11 Coordination of Care

                   11.1 Coordination of Care with AHCCCS Plans, PCPs and Medicare Providers

                   11.2 Coordination of Behavioral Health Care with Other Governmental Entities

                   11.3 Coordination of Care for Referrals to In-network Inpatient and Chemical Dependency (CD) Residential Facilities

                   11.4 Coordination of Care for Members Who are Incarcerated

Chapter 12 Quality Management and Performance Improvement

                    12.1 Performance Improvement Projects

                    12.2 Peer Review

                    12.3 Behavioral Health Consumer Satisfaction Survey

Chapter 13  Service Authorization

                    13.1 Technology

                    13.2 Pre-admission Screening and Resident Review

                    13.3 Concurrent Review

                    13.4 Discharge Planning

                    13.5 Retrospective Review

Chapter 14 Care Coordination

                   14.0 Case Management and Disease Management

                   14.1 Care Management

                   14.2 Health Risk Assessment (HRA) (NEW! Sept. 2016)

Chapter 15 Service/Drug Utilization

Chapter 16 Contract Compliance

                    16.1 Communication of System Changes and Program Requirements

                    16.2 Verification of U.S. Citizenship or Lawful Presence for Public Behavioral Health Benefits

                    16.3 Reporting Discovered Violations of Immigration Status

                    16.4 Duty to Report Abuse, Neglect or Exploitation

                    16.5 Duty to Warn

Chapter 17 Corporate Compliance

                   17.1 Corporate Compliance- Integrated Health Home (IHH), Behavioral Health Home (BHH) and Other Provider Requirements

Chapter 18 Demographic and Other Member Data

Chapter 19 Reporting Requirements

                   19.1 Reporting and Monitioring the Use of Seclusion and Restraint

                   19.2 Reporting of Incidents, Accidents and Deaths (UPDATE! January 2017)

                   19.3 Encounter Validation Studies

  Chapter 20 Grievance Systems and Member Rights

                   20.1 Complaint Resolution

                   20.2 Conduct of Investigations Concerning Person with Serious Mental Illness

                   20.3 Notice and Appeal Requirements (SMI and Non-SMI/Non-title XIX/XXI)

                   20.4 Contractor and Provider Claim Disputes

Chapter 21 Financial Reporting Guide