HealthChoices Provider FAQs
Network Management
When will I receive my provider contract?
The provider contract will be issued once the credentialing process is completed.
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If the credentialing and contracting process is not yet completed, will I be able to see members?
No. However, if there is a clinical reason (approved by a Care Manager) why a member would need to be seen by you prior to the completion of the network participation process, a nonparticipating provider agreement will need to be completed for the member until the credentialing and participating provider contract process is complete.
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Who do I call with questions regarding credentialing or contracting status?
Contact your provider relations representative at 1-888-251-2224.
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How often will I be notified of authorizations?
Authorization and Outpatient Registration reports are sent weekly. For some services, you will also be notified verbally at the time the service is authorized.
Authorizations and Outpatient Registration notifications can also be obtained electronically. Please contact your Provider Relations Representative for more information.
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Can the Authorization reports be sent to more than one location for large organizations?
No, the paper authorization reports are only mailed to one location and will be sent to the administrative address identified on your credentialing application. Contact your provider relations representative if you need to change the identified contact or address where authorization and outpatient registration reports are mailed.
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What do I do if I have a waiting list and can not see a member within the required access standards?
Contact the member services line to notify us and we can assist with locating a provider that can see the member within access standards.You must also notify your Provider Relations Representative immediately in writing.
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How do I register to complete Outpatient Registrations on the website?
Please contact your provider relations representative or go to the Community Care website (www.ccbh.com) and print out the necessary forms.
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How much time will I have to enter Outpatient Registrations for consumers already in treatment?
Registration should be submitted following the initial outpatient visit; not to exceed the timely filing limits for claims submission for the Member’s product coverage.
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What happens when the member is in treatment with another provider?
Community Care will not reject the second registration, but it will be important for providers to address this from a clinical perspective (i.e., does it make clinical sense for members to be seeking services for the same type of care from more than one provider).
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What is a Serious Emotional Disturbance (SED) plan?
Children and adolescents with Serious Emotional Disturbance (SED) include those who meet all three criteria below:
- Age: Birth to less than 18 (or up to age 22 and enrolled in special education services).
- Currently or at any time in the past year have had a DSM-IV diagnosis (excluding those whose sole diagnosis is mental retardation or a “V” code) resulting in functional impairment that substantially interferes with or limits the child’s role or functioning in the family, school or community activities.
- Receive services from mental health and one or more of the following:
- Mental Retardation
- Children and Youth
- Special Education
- Drug and Alcohol
- Juvenile Justice
- Physical Health Plan (the child or adolescent has a chronic health condition requiring treatment)
- Identified as needing mental health services by a local interagency team, e.g., CASSP Committee, Cordero Workgroup.
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What happens if I forgot to check Eligibility Verification System (EVS)?
You will not get paid if the member is ineligible with Community Care on the date of service. Providers must check eligibility frequently to ensure that claims can be processed. The registration of a member will remain active even if the member loses eligibility for part of the year and then regains it later. Providers will not need to register members again if eligibility is re-established.
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How will I know which other providers are within the network?
Call the Customer Service Line to inquire. Provider directories are available and updated semi-annually.
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