Community Behavioral Health Services - San Francisco Department ...

Staff ID and Service and Billing PrivilegesI. Verification and Certification:Per the Office of Inspector General (OIG), California Department of Health Care Services (DHCS), andCalifornia Department of Mental Health (DMH), counties are mandated to verify and certifyindividuals and/or organizational providers including contractors in their system, must be checkedagainst the OIG Exclusion List, the Medi-Cal List of Suspended or Ineligible Providers Lists, LicensingBoards, California Alcohol and Drug Programs (ADP) Certification/Registration lists, and theExcluded Parties List System prior to assigning Staff IDs for documentation and billing, includingMAA billing.The Community Programs Compliance Unit will be responsible for Verification and Certification.Verification will be done on a regular basis.II.Request for New Staff ID:For new Staff ID request, please see attached Verification and Credentialing for Staff ID form. Thisform is divided into two separate parts. The first part is the Credentialing and Verification informationthat is needed. The second part is Attestation for Non-Licensed Staff.III.Instructions for requesting a NEW Staff ID:1) The Credentialing and Verification for Staff ID form(s) need to be completed, and signed.2) For unlicensed staff the Attestation for Non-Licensed Staff form needs to be completed and signedby the staff’s supervisor or director.3) If the employee needing a new staff ID will be seeing clients in a Substance Abuse program, acopy of the staff’s certification or registration is needed. ExpiredCertification orexpired registration in not accepted.4) For new request, the attached User Confidentiality, Security and the Electronic SignatureAgreement Form MUST accompany the Verification and Credentialing for StaffID form5) All the above MUST be faxed to the AVATAR Accounts Manager at (415) 252-3008 or (415) 255-3548.Request to Update staff information:Please use the Credentialing and Verification for Staff ID for to update any staff information. This staffMUST already have been assigned a staff ID.Instructions for Updating staff information:1) Check the appropriate box that need to be updated2) Enter the employee’s staff ID3) If Substance Abuse Program, and updating information regarding certification or registration, acopy of the certification or registration must accompany the Credentialing and Verification forStaff ID form.4) All the above MUST be faxed to the Community Programs Compliance Unit at (415) 252-3032.2