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Provider Manual and Alerts
The HealthChoices Provider Manual is designed to introduce you to Community Care and provide you with phone numbers as well as instruction regarding authorizations, billing, and quality of service.
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| Provider Manual By Chapter+ Expand All- Collapse All |
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+ Welcome
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- Welcome
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Welcome Chapter
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110KB
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11 pages
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PDF
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Welcome to the Community Care HealthChoices Network
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HealthChoices Key Contact Page
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Guidelines for Obtaining Approval for In-Plan and Supplemental Services
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+ I. About Community Care
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- I. About Community Care
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Chapter I
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105KB
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15 pages
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PDF
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I.A Code of Ethics
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I.B Cultural Competency Vision
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I.C Overview of Quality Management
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I.D Compliance with Fraud and Abuse Reporting
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I.E Our Care Management Team
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+ II. About Community Care HealthChoices Members
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- II. About Community Care HealthChoices Members
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Chapter II
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175KB
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30 pages
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PDF
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II.A Member Rights and Responsibilities
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II.B Member Help in Selecting Providers
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II.C Member Satisfaction
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II.D Member Behavioral Health Preventive Health Programs
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II.E Member Complaint and Appeal Procedures
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II.F Member Grievances
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+ III. About Being a Community Care HealthChoices Provider
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- III. About Being a Community Care HealthChoices Provider
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Chapter III
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200KB
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33 pages
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PDF
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III.A Practitioner Credentialing, Contracting, Recredentialing
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III.B Facility/Organization Assessment, Contracting, Reassessment
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III.C Confidentiality and Disclosure Policies
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III.D Record Keeping Standards
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III.E Clinical Practice Guidelines
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III.F New Technologies
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III.G Unusual Incidents/Significant Member Incident Reporting (Patient Safety)
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III.H Provider Cultural Competency
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III.I Comprehensive Provider Evaluation Process (CPEP)
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III.J Provider Satisfaction
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III.K Provider Education
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III.L Provider Advisory Committee
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+ IV. Providing Services to HealthChoices Network Members
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- IV. Providing Services to HealthChoices Network Members
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Chapter IV
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95KB
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11 pages
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PDF
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IV.A Verifying Member Eligibility for HealthChoices Network Services
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IV.B Medical Necessity (Level of Care) Criteria
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IV.C Obtaining Approval to Provider Services (Outpatient Registration, Precertification, Authorization)
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IV.D Standards for Member Access to Services (Appointments)
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IV.E Coordination of Care, Referrals, Transition of Care to Other Providers
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IV.F Care Management Services
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+ Billing Manual
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- Billing Manual
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Billing Manual
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180KB
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23 pages
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PDF
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+ Glossary of Terms and Abbreviations
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- Glossary of Terms and Abbreviations
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Glossary of Terms and Abbreviations
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50KB
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4 pages
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PDF
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+ Appendices
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- Appendices
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Appendices
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470KB
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93 pages
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PDF
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A.1 Fraud, Waste, and Abuse Compliance and Auditing Policies and Procedures
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B.1 Consents for Release of Information Forms and for Physical Health/Behavioral Health Collaboration
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C.1 Priority Populations
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D.1 Behavioral Health Managed Care Organizations (BH-MCOs) Performance/Outcome Management System (POMs)
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E.1 Companion Guide for Northeast Counties
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F.1 Companion Guide for North Central Counties
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Chapter 1101 of the Pennsylvania Code sets forth the Medical Assistance regulations and policies which apply to providers. Regulations specific to each type of provider are located in the separate chapters relating to each provider type. View Chapter 1101 of the Pennsylvania Code.
Throughout the year we issue Provider Alerts which are official updates to the main manual. Please print and save these updates and keep them with your manual. Alerts apply to all counties except where noted.
The information in Provider Alerts prior to 2009 is included in the Provider Manual at the top of the page. The archive below is available for your convenience.
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