2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Behavioral HealthTelephone numberStatus (including changes in the numbers ofservice slots available)Services provided (with updated programdescriptions)Ability to accept Centennial Care referralsTaxpayer identification numberGroup practice membershipStaff rostersProviders may submit new or updated informationonline or by mail, phone, or fax using the contactinformation below.Presbyterian Behavioral HealthP.O. Box 25926Albuquerque, NM 87125-5926Phone: 505-923-5678Expectations of the Medicaid ProviderCentennial Care behavioral health providers agreetoBe available to accept referrals of CentennialCare members within the scope of theprovider’s practiceDeliver services in accordance with the termsof New Mexico Medicaid regulations, thePresbyterian PPA, and policies andprocedures outlined in this manualRender all services in the provider’s office, orin facilities or locations that are mutuallyagreed upon under the terms of thePresbyterian PPAInitiate authorizations as required byPresbyterianExpectations of Medicaid Members and TheirFamiliesAs an organization, Presbyterian strongly endorsesconsumer empowerment and family involvement.Experience shows that when members arevoluntarily engaged in the management of theirbehavioral health services, they are generally morecompliant with treatment and medications. Thiscompliance in turn leads to more positiveoutcomes.Presbyterian not only encourages members andtheir families to become active participants intreatment, we believe that members and familieshave a responsibility to do so. Providers arerequired to document member and familyinvolvement in all treatment records, and todemonstrate compliance with this requirementduring site visits and audits.Care Coordination CommunicationRequirements (for Commercial and Medicare)We require that communication take place betweenthe behavioral health practitioner and the managedcare member’s primary care provider (PCP), withinseven days of admission to a behavioral healthservice, upon any significant change in themember’s behavioral health status, and upondischarge from services. Documentation of thiscommunication must be evident in the managedcare member’s medical record. Presbyterian haspolicies and procedures in place to help with suchcommunication, such as the Coordination of Careform. If used, Presbyterian’s Coordination of Careform meets the documentation requirements andcan be accessed through the provider web page at9-52014 Practitioner and Provider Manual - Ver. 3