Provider Policies
PerformCare policies posted to this website are updated annually. It is possible a more current version of a policy is available. Please contact your Account Representative or Care Manager for such policy inquiries. Provider notices have been moved to a separate page.
Navigate directly to a letter:
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A
- ACT & CTT Authorization Requests
- Administrative Appeal Process
- Advance Directives for Adult Members
- Approval/ Denial Process and Notification
- Assessment of Provider Cultural Humility and Awareness
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B
- BHT and BHT-ABA Skills, Training, and Development Payment Process
- Bed Hold Payment and Therapeutic Leaves for MH IP, RTF, and SU Non-Hospital Facilities
- Best Practice Evaluation (BPE) and Continued Care Eval Requirements
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C
- CRR-HH Authorization and Re-authorization Requests
- Clinical Care Management Decision Making
- Community Residential Rehabilitation Host Home (CRR-HH) Therapeutic Vacation
- Community Residential Rehabilitation-Host Home (CRR-HH) Pre-Discharge Planning Meeting Requirements
- Community Residential Rehabilitation-Host Home (CRR-HH) Pre-Discharge Planning Meeting Requirements
- Continued Stay Review Process for Services with Telephonic Review
- Credentialing Committee
- Credentialing Progressive Disciplinary Actions for Providers
- Credentialing and Re-credentialing Criteria - Facilities
- Crisis Intervention Services Authorization Procedure
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D
- DHS Notification of Drop in Provider Capacity
- Development and Monitoring of Quality Improvement Plans Issued by the Special Investigations Unit
- Dissatisfaction Complaint Process for Members
- Documentation Standards for Providers
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E
- Electroconvulsive Therapy (ECT) Requests for Initial, Continuation and Maintenance
- Emergency Services-Coverage/Reimbursement
- Expansion Request Process for State Plan Service for Providers
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F
- FQHC Access for PerformCare Members
- Family Based Mental Health Services (FBMHS) Discharge Planning
- Family Based Mental Health Services (FBMHS) Prior to Discharge in a Residential Treatment Facility (RTF) or CRR-Host Home
- Family Based Mental Health Services (FBMHS) Prior to Discharge in a Residential Treatment Facility (RTF) or CRR-Host Home (CRR-HH)
- Family Based Mental Health Services (FBMHS) Procedure for Prior Authorization
- Family Based Mental Health Services (FBMHS) Procedure to Request Additional Service Units and Extension Requests
- Family Based Mental Health Services (FBMHS) and use of Family Support Services (FSS)
- Family Based Mental Health Services (FBMHS) in Conjunction with Targeted Case Management (TCM)
- Family Based Mental Health Services (FBMHS) in the Emergency Department
- Fraud Waste and Abuse Program
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G
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I
- IBHS Additions or Increasing Units During a Current Authorization
- IBHS Group, EBP, and Other Individual Services Authorization Requests
- IBHS Requests needing School, Daycare, and Other Community Program Input
- Individual IBHS and ABA Services Authorization Requests
- Individual Intensive Behavioral Health Services (IBHS) Concurrent Requirements with CRR-HH/CRR-ITP or RTF Prior to Discharge
- Inpatient Services Service Denial-Behavioral Health
- Inpatient and Partial Hospitalization (Mental Health) Programs Authorization Requests
- Inpatient and Residential Treatment Aftercare Referrals
- Intensive Behavioral Health Services (IBHS) Service Capacity and Referral Monitoring: Individual BC/MT/BHT & ABA Services – BA, BC-ABA Asst. BC-ABA/BHT-ABA
- Interpreter Cost Reimbursement Process
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M
- MA Enrollment Applications Processing (In Lieu of and in Addition to Services and Out of Network Enrollment for Provider)
- MH Outpatient Psychiatric Bundling of Services Expectations
- Medical Necessity Criteria Distribution to PerformCare Providers
- Mobile Mental Health and Intellectual Disability (MH/ID) Requests for Initial and Continued Services
- Music Therapy Services Authorization and Delivery
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O
- Out-Of-Network Provider Authorization Procedures and Standards
- Outpatient Treatment Requests, Denials, and Authorizations
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P
- Payment Adjustments for Provider-Preventable Conditions including Health Care-Acquired Conditions
- Payment Authorization Procedures for all Levels of Care
- Provider Audits Conducted by the Special Investigations Unit
- Provider Complaint Process
- Provider Dispute Policy
- Provider Notification to PerformCare of Inpatient Stays When Member has Other Primary Insurance
- Provider Profiling Reports
- Provider Transfer Process for Children’s Services
- Psychological and Neuropsychological Testing Authorization
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Q
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R
- RTF Authorization and Re-authorization Requests
- Rate Setting Process for all Levels of Care
- Recipient Verification of Services
- Reporting Suspected Provider Fraud, Waste and Abuse
- Residential Treatment Facility (RTF) Pre-Discharge Planning Meeting Requirements
- Restraint and Seclusion Monitoring
-
S
- Satisfaction Surveys for Members and Providers
- Sentinel Event Review Process
- Sentinel Event Review Process
- Site Visits - Non-Routine
- Six-Criteria Complaint Process for Members
- Substance Use Disorder Services Authorization Requests
- Substance Use Hospital and Non-Hospital Based Withdrawal Management Authorization Requests
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T
- Targeted Case Management Contact Expectations
- Targeted Case Management Initial and Reauthorization Requests and Discharges
- Targeted Case Management Reimbursable and Non-Reimbursable Services
- Targeted Case Management Role Expectations
- Team Meeting and ISPT Meeting Expectations and Requirements for Children's Services
- Transcranial Magnetic Stimulation (TMS) Requests
- Treatment/Service Record Reviews
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U
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