GHP Family Provider Manual - Geisinger Health Plan

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County Behavioral Health Plan Phone number En Español TTY/TDDCentreClintonColumbiaJuniataLackawannaLuzerneLycomingMifflinMonroeMontourNorthumberlandPikeSchuylkillCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.com(866) 878-6046 (866) 229-3187 (877) 877-3580(855) 520-9787 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 668-4696 (866) 229-3187 (877) 877-3580(866) 668-4696 (866) 229-3187 (877) 877-3580(855) 520-9787 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 473-5862 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 473-5862 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-35809
County Behavioral Health Plan Phone number En Español TTY/TDDSnyderSullivanSusquehannaTiogaUnionWayneWyomingCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.comCommunity CareBehavioral Healthhttp://www.ccbh.com(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 668-4696 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 878-6046 (866) 229-3187 (877) 877-3580(866) 668-4696 (866) 229-3187 (877) 877-3580County Behavioral Health Crisis Intervention contact information:In the event of a life-threatening emergency, please dial 9-1-1.County Toll Free Phone Number Non -Toll Free Phone NumberBradford (877) 724-7142 N/ACarbon (800) 338-6467Centre (800) 643-5432 N/AClinton(800) 525-7938Drug & Alcohol: (888) 941-2721Columbia (800) 222-9016(610) 377-0773 (MH/DS)(570) 992-0879TTY: 570-420-1904(570) 326-7895Drug & Alcohol: (570) 323-8543(570) 275-4962(Daytime, weekdays only)Juniata (800) 929-9583 N/ALackawanna N/A (570) 348-6100Luzerne Child Crisis only: (888) 829-1341 (570) 552-600010
Page 1 and 2: HealthChoices Provider ManualRevise
Page 3 and 4: Case Management 23Complement the Ca
Page 7 and 8: CONTACT INFORMATIONAll paper Claims
Page 9: Name Phone Number Hours of Operatio
Page 13 and 14: County Local Phone Number Toll Free
Page 15 and 16: discovery by any party of any incid
Page 17 and 18: Assignment of NewbornsNewborns are
Page 19 and 20: AllSCP:OtolaryngologyDermatologyPed
Page 22 and 23: • Report any unusual or group exp
Page 24 and 25: MEDICAL MANAGEMENT & PRIOR AUTHORIZ
Page 26 and 27: • Coronary Artery Disease (CAD)Ma
Page 28 and 29: Risk stratificationCase Managers/He
Page 30 and 31: If additional information is needed
Page 32 and 33: Prior to a planned inpatient admiss
Page 34 and 35: Preferred Modes of Data Submission
Page 36 and 37: Member is admitted to a Nursing Fac
Page 38 and 39: A Participating Provider rendering
Page 40 and 41: phone to the Medical Management Dep
Page 42 and 43: Completing Medical Management Depar
Page 44 and 45: (800) 270-9981 or (570) 271-5301Fax
Page 46 and 47: GHP Family will assist Members in a
Page 48 and 49: Pharmacy Department(855) 552-6028 o
Page 50 and 51: A GHP Family Pharmacist will perfor
Page 52 and 53: • New prescriptions for atypical
Page 54 and 55: Requesting PrecertificationRequests
Page 56 and 57: Network AccessGHP Family Members ha
Page 58 and 59: Requirements for Medicaid Maternity
Page 60 and 61:
• Continue a Member restriction f
Page 62 and 63:
Covered ServicesPlease note the inf
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
• Antineoplastics (cancer drugs)
Page 74 and 75:
• Smear, primary source, with int
Page 76 and 77:
Payment for Medically Necessary Ser
Page 78 and 79:
GHP Family will neither unreasonabl
Page 80 and 81:
• Name and address of facility wh
Page 82 and 83:
DPW defines “Complaint” and “
Page 84 and 85:
Second Level45 days from the date t
Page 86 and 87:
Timeframes for Resolution of Compla
Page 88 and 89:
and make a determination. If the pr
Page 90 and 91:
arrangements for personal interpret
Page 92 and 93:
• Documenting requests and action
Page 94 and 95:
employee, or a Member, among others
Page 96 and 97:
PROVIDER SELF-AUDIT PROTOCOLThe Pen
Page 98 and 99:
• Agreement termination by the GH
Page 100 and 101:
Early and Periodic Screening, Diagn
Page 102 and 103:
Medically Necessary or Medical Nece
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GHP Family Provider Manual - Geisinger Health Plan

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