FBHPartners Provider Handbook Supplement (PDF)

The Foothills Behavioral Health Partners’ Provider Handbook (provided by ValueOptions®) serves as a supplement to the ValueOptions® Participating Provider Handbook and provides a quick reference guide about policies and procedures specifically related to FBH Partners.

Introduction

• Welcome
• General Information
• Colorado Medicaid BHOs

Continuum of Services

• Clinical Services Descriptions

Provider Assistance & Referrals

• Clinical Operations
• Customer Service Department
• Network Credentialing
• Tele-Connect and ProviderConnect
• Provider Availability and Access to Care Standards
• Referrals
• How Clients Access Behavioral Health Care

Utilization Management Procedures

• Overview
• Care Management Functions
• Authorizations
• Medical Record Requirements
  Advanced Directives
• Psychological Testing Evaluation Form – Click Here
  

Client Choice of Providers

• Member Choice

Second Opinion

• Second Opinions in a Disagreement with Treating Provider
• Second Opinions in a Disagreement with a Notice of Action

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

• Case Managers
• Care Providers
• How to Access EPSDT Services

Coordination of Care

• Provider Responsibilities
• Getting Member’s a PCP
• Coordination with Other Agencies

Reviews, Reconsiderations and Appeals

• Contacting Member and Family Affairs for Assistance
• Clinical Guidelines
• Peer Reviews
• Requesting Reconsideration
• Retrospective Authorization Process
• Member’s Request for Appeal of an Action
• Member’s Request for a State Fair Hearing
• Continuing Services
• Definitions
• DCR (Designated Client Representative) Form

Network Credentialing

• Credentialing and Recredentialing Standards
• Contract Requirements
• Credentialing Committees
• Termination, Sanctions and Appeals
• Change of address form – Click Here

Benefits Summary

• Colorado Medicaid Exclusions
• Benefit Limites

Colorado Client Assessment Client Record (CCAR)

• CCAR Requirements
• CCAR Form Example
• CCAR Website Link - Click Here

Billing for Services

• Billing for Services
• Electronic Claims Submission
  • Claims Appeals
• Colorado Medicaid Adjustment Form – Click Here
• Covered Diagnoses – Click Here

Quality Improvement

• Program Integrity
• Adverse Incidents
• Provider Quality Improvement Program
• Quality of Care
• Treatment Record Audits
• Confidentiality
• Adverse Incident Form

Office of Member and Family Affairs

• General Information
• Member and Family Input
• Cultural Competency
• Grievances and Appeals of Actions
• Compliments
• Ombudsman Flier in English – Click Here
• Ombudsman Flier in Spanish – Click Here
• Member Rights Poster – Click Here

Transportation

• Making Transportation Arrangements

FBHPartners Specific Contract Requirements

• Medication Evaluation Referral Form – Click Here (Coming Soon)
• LOCUS/CALOCUS Form – Click Here (Coming Soon)
• EPSDT Screenings
• Coordination of Care

Community Mental Health Center Sites

Documentation Standards

• General Requirements
• Service/Treatment Plans
• Progress Notes

Treatment Systems Level of Care and Diagnosis-Based Treatment Guidelines

• Treatment Guidelines Page – Click Here

Sample Clinical Forms

• Clinical Forms – Click Here