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Provider Manual

CT BHP Provider Manual – Complete Edition

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SECTION I - INTRODUCTION

(OVERVIEW OF THE CONNECTICUT BEHAVIORAL PARTNERSHIP (CT BHP))


SECTION II - PARTICIPATING AS A CT BHP PROVIDER

(PROVIDER ENROLLMENT, PROVIDER RESPONSIBILITIES, SUPPORTS AVAILABLE TO CONNECTICUT BEHAVIORAL HEALTH MEDICAL ASSISTANCE PROGRAM NETWORK PROVIDERS)


SECTION III - VERIFYING MEMBER ELIGIBILITY

(OPTIONS FOR VERIFYING MEMBER ELIGIBILITY FOR CT BHP SERVICES)


SECTION IV - UTILIZATION MANAGEMENT AND CARE 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 REGISTRATION/AUTHORIZATION, PARTICIPATING IN A CONCURRENT (CONTINUING STAY) REVIEW, RETROACTIVE ELIGIBILITY, DISCHARGE & AFTER CARE PLAN)


SECTION V - QUALITY & NETWORK MANAGEMENT

(FILING INQUIRIES, COMPLAINTS, GRIEVANCES AND COMPLIMENTS, FILING ADMINISTRATIVE APPEALS, FILING CLINICAL APPEALS, CRITICAL INCIDENTS, SERIOUS OCCURENCES AND ADVERSE INCIDENTS REPORTING, SITE VISITS FOR QUALITY REVIEWS)


SECTION VI - PROVIDER RELATIONS


SECTION VII - COMPLIANCE DEPARTMENT

(HONORING MEMBER RIGHTS)


SECTION VIII - 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, & COORDINATION, FREESTANDING MEDICAL/PRIMARY CARE CLINICS, HOSPITAL EMERGENCY DEPARTMENTS, HOSPITAL INPATIENT SERVICES, HOSPITAL OUTPATIENT CLINIC SERVICES, LONG TERM CARE, MENTAL HEALTH CLINICS, MEDICATION-ASSISTED TREATMENT, MULTI-DISCIPLINARY EXAMINATIONS, SCHOOL-BASED HEALTH CENTER SERVICES)


APPENDIX B: GLOSSARY OF TERMS