TABLE
OF CONTENTS
I. OVERVIEW
About the
Manual
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/Privileging
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. Compliance
Policy
k.Sanction
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.Jail
Diversion Policy
h. Person-Centered
Planning Policy
i. Practice
Guidelines for Person Centered Planning
j. Self-Determination
k. Person
Centered Planning
IV.
UTILIZATION MANAGEMENT
a. Service
Authorization Policy
V. ADVANCE
DIRECTIVES
a. Advance
Directives/Durable Power Of Attorney
b. Plan
for Difficult Times
VI.
GRIEVANCE & APPEALS
a. Consumer
Grievance & Appeals Policy
b. Attachment
1 Summary of Resolution Processes
VII.
MEMBER SERVICES
a. Member
Services Policy
b. Customer
Handbook
c. Cultural
Competency Plan
VIII.
PRACTICE GUIDELINES
a. Family
Psycho-Education
b. Parent Management
Training
IX.
QUALITY IMPROVEMENT
a. Quality
Assessment and Performance Improvement Plan (QAPIP)
b. Quality
Management Policy
c. Sentinel
Events Reporting (See Sentinel Events Policy)
X. CLAIMS
MANAGEMENT
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