2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Behavioral Healthother individual providers on staff or it may contractwith physicians and other individual providers toprovide behavioral health services.Core Service AgenciesCSAs are designated by the state to manage muchof the service delivery of behavioral health services.CSAs also provide prevention, early intervention,treatment, and recovery services related tobehavioral health for members. CSAs arecontracted as organizations and are required toprovideCrisis intervention 24 hours a day, seven daysa weekBehavioral health servicesAccess to psychiatric evaluationsAccess to medication managementBehavioral health out-of-home assessmentand service planningCare coordination to members with seriousmental illness or serious emotionaldisturbanceAccess to a range of other clinical behavioralhealth servicesAccess to comprehensive community supportservicesAll behavioral health providers are expected tohave a current description of the behavioral healthservices they provide on file with Presbyterian forinclusion in our provider directory and to assist withreferrals to our behavioral health providers.CredentialingIn order to be eligible for referrals, Presbyterianbehavioral health providers are required to undergothe credentialing review process before beingaccepted as Presbyterian providers, and periodicrecredentialing thereafter (see the Recredentialingsection in this chapter). Presbyterian has delegatedbehavioral credentialing for the Centennial Careprogram to Magellan. Magellan’s CredentialingVerification Organization department is responsiblefor completing credentialing activities according toNational Committee for Quality Assurancestandards, and the requirements of Presbyterianand the Centennial Care program.Provider Credentialing Application ProcessProvider credentialing is initiated through theprovider application process. Individual providersare asked to submit the following documents, alongwith a fully completed application, to facilitate thecredentialing review:Copies of current licenses and certificationsEducation and training documentationMalpractice insurance informationForm W-9Organization providers are asked to submit thefollowing documents, along with a fully completedapplication, to facilitate the credentialing review:Copies of current licenses (if applicable)Copy of current accreditationsProof of professional liability insurance(minimum amounts of $1 million/$3 million)Proof of general liability insurance9-32014 Practitioner and Provider Manual - Ver. 3