Provider Manual -
TABLE OF CONTENTS
I. OVERVIEW
Provider Manual - Address-Phone-Key Personnel-Hours
a. NorthCare Network
b. Organizational Structure
c. Affiliates
d. Acronym
List
II.
PROVIDER NETWORK
a. Network
Procurement Process Policy
b. Criminal
Background Checks
c. Credentialing
Policy
d. Staff
Competency/Education Policy
e. Provider
Grievance and Appeals
(See “Provider Network Management and Appeals” Policy)
f. Managing
the Substance Abuse Provider Network Policy
g. Delegated Functions: Please refer to your contract
h. Provider
Network Selection, Management and Appeal Mechanisms
i. Out
of Network Reimbursement for Hospital Based Services
j. Anti-Retaliation Policy -- Compliance Policy
k.Sanction
Policy
l. Privileging
Policy
j. NorthCare (ELMER) EHR Privacy Policy
k. NorthCare (ELMER) EHR Security Policy
III.
PROVIDING CONSUMER SERVICES
a. Access
Policy & Overview of Access Process
b. Accessibility
& Accommodation Policy & Procedure
c. Behavior
Management Review Policy
d. Consumer
Employment Policy
e. Coordination
of Care Policy
f. Inclusion/Prevention
of Relapse Policy
g. Independent
Facilitation of a Person-Centered Plan
h. Individual Plan of Service for Integrated Treatment Policy
- Family Centered Advisory
- Policy P3.4.1.1 PCP
- Policy self determination guideline
- NC IPOS policy
i. Jail
Diversion Policy
j. Jail Diversion Final Guidelines
k. Practice
Guidelines for Person Centered Planning
l. Person
Centered Planning
m. Person-Centered Planning Revised Policy Practice Guideline
n. Recovery Based Services
IV.
UTILIZATION MANAGEMENT
Utilization
Management Plan
Attachment 1 - Attachment 2 - Attachment 3 - Attachment 4
V. ADVANCE
DIRECTIVES
a. Advance
Directives/Durable Power Of Attorney
b. Plan
for Difficult Times
c. Advance
Directives/Durable Power of Attorney/ Plan for Difficult Times
VI.
GRIEVANCE & APPEALS
a. Consumer
Grievance & Appeals Policy
b. Attachment 1 Summary of Resolution Process
c. Enrollee
Rights and Protections
d. Recipient
Rights For Substance Abuse
Attachment
VII.
CUSTOMER SERVICES
a. Customer
Services Policy
b. Customer
Handbook
c. Cultural Diversity Policy
VIII.
PRACTICE GUIDELINEMANUAL
IX.
QUALITY IMPROVEMENT
a. Quality
Assessment and Performance Improvement Plan (QAPIP)
b. Quality
Management Policy
c. Sentinel
Events Reporting (See Sentinel Events Policy)
X. CORPORATE COMPLIANCE
a. Code of Compliance Ethics
b. Regulatory Compliance Program Plan
c. Regulatory Compliance Program Policy
d. Regulatory Compliance Program Reporting and Investigative Procedures
IX. NORTHCARE DIRECTIVES
a. NorthCare Directives Policy
b. Documentation and SAL Requirements for Services Provided by Sub-Contractors or CMHSP Staff
c. Training Requirements for Child Mental Health Professionals (CMHP)
d. Designated Record Set Directive
e. ACT (Assertive Community Treatment) Billing & Coding
d. Documentation in Consumer Record
NorthCare Policies/Procedures/Plans
Benefit Plan Developmental Disabilities
