Provider Manual -

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

 

 

Notice of Privacy Practices

NorthCare Policies/Procedures/Plans

Benefit Plan Developmental Disabilities

Benefit Plan Mental Illness

NorthCare Network Organizational Chart

 


NorthCare is always interested in hearing consumer feedback and suggestions. To contact us please call 1-888-333-8030 or email solson@up-pathways.org.


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