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Provider Manual

CT BHP Provider Manual – Complete Edition

Also printable by section:

SECTION I   Introduction
(Welcome to Providers from the Departments, Overview of the Connecticut Behavioral Health Partnership, Quick Reference Guide to the Partnership)

SECTION II  Participating as a CT BHP Provider
(Provider Enrollment, Participating Provider Responsibilities, Supports Available to CT BHP Network Providers)

SECTION III  Verifying Member Eligibility
(Options for Verifying Member Eligibility for CT BHP Services)

SECTION IV  CT BHP Approach to Care Management and Utilization Management
(Utilization Management Criteria, Working with Care Managers, Critical Elements in Treatment and Recovery Plans, Other Reviews Conducted by CT BHP, Overview of Authorization and Registration of Services, The Process of Service Authorization, Participating in a Concurrent (Continuing Stay) Review, Discharge and After Care Plan)

SECTION V & VI  Quality and Network Management & Provider Relations

SECTION VII  Compliance Department
(Honoring Member Rights, Filing Inquiries, Complaints, Grievances and Compliments, Denials, Filing Administrative Appeals, Filing Medical Necessity Appeals, Adverse Incidents Reporting)

SECTION VIII  Recovery and Resiliency
(Principles of Recovery and Resiliency)

SECTION IX  Interface Across Delivery Systems
(Collaboration Across Delivery Systems, Overview of Services Covered by the CT BHP, Overview of Services Covered Under Medical Benefits)

Appendix A  Mixed Services Protocols
(Ancillary Services, Co-Occurring Medical and Behavioral Health Conditions (Screening, Referral, and Coordination), Freestanding Medical/Primary Care Clinics, Hospital Emergency Departments, Hospital Inpatient Services, Hospital Outpatient Clinic Services, Long Term Care, Mental Health Clinics, Methadone Maintenance, Multi-Disciplinary Examinations, School-Based Health Center Services)

Appendix B  Glossary of Terms