HealthChoices Provider FAQs
Child and Adolescent Services
What is a transition of care authorization?
Transition of care authorizations include existing services which began prior
to January 1, 2007 and extend beyond this date.
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When can providers send transition of care authorizations to Community Care?
Providers can begin sending transition information anytime after
November 13, 2006.
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If our contract with Community Care is not yet finalized, should we wait to send the transition of care information?
No, do not wait. Send the information anytime after November 13, 2006.
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What children’s services must be pre-authorized?
All Behavioral Health Rehabilitation Services (BHRS) — including Therapeutic Staff Support (TSS), Mobile Therapist (MT), Behavioral Specialist Consultant (BSC) and Summer Therapeutic Activity Program (STAP); Residential Treatment Facility (RTF) services — including Therapeutic Foster Care (TFC) and Community Residential Rehabilitation (CRR); Family Based Mental Health Services (FBMHS); and Inpatient admissions, Psychological/Neuropsychological Testing (outpatient services), and admission to Partial Hospitalization.
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Can services begin without a pre-authorization?
No, do not start to deliver services without an authorization from
Community Care.
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Are there any services within Behavioral Health Rehabilitation Services
(BHRS) in which providers can obtain an authorization after the service has been delivered?
Yes, you can seek an authorization for a Best Practice evaluation (either initial or continued stay) as well as for the prescriber’s attendance at the interagency
meeting (either initial or continued stay). The authorization request form must
be submitted to Community Care within 30 days of the actual service date.
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We have already developed packets for services to begin or continue on January 1, 2007, using the Fee-for-Service paperwork and timelines, what should we do?
Community Care will accept these packets; however, it is our expectation that
providers will move toward Community Care forms and timelines as soon as
possible.
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How do I know whether to submit continued-stay packets to the state or Community Care?
Providers need to check the Eligibility Verification System (EVS) daily
during this transition time to determine if the member is a HealthChoices
member who is eligible with Community Care. If so, the packet should be sent
to Community Care.
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Will Community Care accept services that have been previously authorized by the state?
Yes, Community Care will automatically accept any services that have been
authorized by the state. However, providers will need to forward to
Community Care all the information that was submitted to the state as well
as the State Notice of Decision.
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Where do I locate Community Care forms?
The forms are located on our website at www.ccbh.com. Please select forms specific to your level of care under the “North Central HealthChoices
Providers” heading.
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How/where do providers send transition-of-care information as well as upcoming initial and continued-stay packets?
Behavioral Health Rehabilitation Services (BHRS) and Residential Treatment
Facility (RTF) — including Therapeutic Foster Care (TFC) and Community Residential Rehabilitation (CRR) — information must be sent by mail to:
North Central RTF Care Manager
Or
North Central BHRS Care Manager
Community Care Behavioral Health
One Chatham Center, Suite 700
Pittsburgh, PA 15219
Family Based Mental Health Services (FBMHS) information can be faxed to the attention of:
Elaine Weissberg @ 1-888-251-0087
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Must we submit one Behavioral Health Rehabilitation Services (BHRS) or Residential Treatment Facility (RTF) packet per envelope?
Community Care has no restrictions on the amount of packets within each envelope.
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What is the Community Care Review process for Behavioral Health
Rehabilitation Services (BHRS), Residential Treatment Facility (RTF) and Family Based Mental Health Services (FBMHS)?
Packets are date stamped upon receipt. A care manager will complete an administrative review to verify that all required documents are present. A
clinical review follows to assess for Medical Necessity. Community Care will
make a medical necessity determination within 2 business days from receipt of the complete packet. Written notification to the member (BHRS and RTF only) and provider will follow. Providers will be verbally notified within 48 hours if additional information is needed to make a medical necessity determination with written request following. The provider will have 5 business days to submit the requested information to Community Care, who will make a medical necessity determination within 2 business days.
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What is the length of time for authorizations?
Residential Treatment Facility (RTF) — including Therapeutic Foster Care (TFC) and Community Residential Rehabilitation (CRR) services — can be requested for up to 90 days.
Behavioral Health Rehabilitation Services (BHRS) can be requested for up to 4 months (defined as 18 weeks) and up to 12 months for those members with a diagnosis in the Autism Spectrum.
Family Based Mental Health Services (FBMHS) can be requested for a one-month period of time.
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How do we contact Community Care?
Provider Line: 1-888-251-2224
Member Service Line: 1-866-878-6046
TTY/TDD: 1-877-877-3580
Spanish Line: 1-866-229-3187
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