Policies and Notices

PerformCare policies and procedures

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.

CC-001: Reporting Suspected Provider Fraud, Waste, and Abuse (PDF) September 13, 2018

Attachments

CC-002: Fraud, Waste, and Abuse Program (PDF) September 5, 2017

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CC-003: Provider Audits Conducted by the Special Investigation Unit (PDF) December 21, 2018

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CC-005: Provider Dispute Policy (PDF) June 8, 2018

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CC-006: Payment Adjustments for Provider-Preventable Conditions Including Health Care-Acquired Conditions (HCACs) (PDF) September 11, 2018

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CC-012: Recipient Verification of Services (PDF) September 11, 2018

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CM-006: Documentation Standards for Providers (PDF) July 1, 2007

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CM-007: Service Denial Behavioral Health Inpatient Services (PDF) November 19, 2018

CM-009: Use of IQ and Adaptive Functioning Testing to Diagnose Mental Retardation (PDF) January 1, 2004

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CM-011: Clinical Care Management Decision Making (PDF) November 19, 2018

CM-012: Authorization of Psychological and Neuropsychological Testing (PDF) November 6, 2018

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CM-013: Denial Notice Procedure (PDF) December 1, 2006

CM-019: Bed Hold Payment and Therapeutic Leaves (PDF) December 1, 2006

CM-020: Provider Notification to PerformCare of Inpatient Stays When Member Has Other Primary Insurance (PDF) January 1, 2004

CM-024: Peer Support and Peer Support Waiver Exceptions (PDF) July 2, 2014

Attachment

CM-028: Authorization Requests for Preauthorized Drug and Alcohol Services (PDF) February 14, 2012

CM-029: Authorization Requests for Drug and Alcohol Hospital and Non-Hospital-Based Detoxifications (PDF) April 11, 2012

CM-034: Emergency Services Coverage Reimbursement (PDF) July 24, 2003

CM-036: Mental Health/Substance Abuse Targeted Case Management Initial and Reauthorization Requests and Discharges (PDF) May 20, 2008

CM-037: Mental Health/Substance Abuse Targeted Case Management Reimbursable and Non-Reimbursable Services (PDF) August 15, 2018

CM-039: Targeted Case Management Contact Expectations (PDF) June 9, 2008

CM-040: Targeted Case Management Role Expectations (PDF) July 1, 2008

CM-042: Continued Stay Review Process (PDF) July 1, 2014

CM-043: Authorization Requests for Preauthorized Mental Health Services (PDF) February 14, 2012

CM-045: Prior Authorization Requests for Electroconvulsive Therapy (ECT) (PDF) April 10, 2012

CM-046: Psychiatric Rehabilitation (PDF) December 1, 2016

Attachment

  • CM-046-01: Attachment 1: Psychiatric Rehabilitation Form (PDF)

CM-047: Authorization and Delivery of Music Therapy Services (PDF) November 13, 2017

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CM-CAS-010: Interagency Services Planning Teams Community Rehabilitation Host Home (CRR-HH) and Residential Treatment Facility (RTF) (PDF) October 1, 2005

CM-CAS-029: Completion and Submission of Best Practice Evaluations and Continued Care Evaluations (PDF) September 13, 2018

CM-CAS-044: Procedure to Request Additional Service Units During an Authorization Period and Extension Requests for Family-Based Mental Health Services (FBMHS) (PDF) February 4, 2019

CM-CAS-047: Pre-Discharge Planning Meeting Requirements for Residential Treatment Facility (RTF) (PDF) October 23, 2018

CM-CAS-048: Pre-Discharge Planning Meeting Requirements for Community Residential Rehabilitation (PDF) October 23, 2018

CM-CAS-050: Community Rehabilitation Host Home (CRR-HH) November 15, 2017 (PDF) November 15, 2017

CM-CAS-051: Procedure for Prior Authorization and Extension Requests for Family-Based Mental Health Services (FBMHS) (PDF) November 15, 2017

Attachments

CM-MS-003: Outpatient Treatment Requests, Denials, and Authorizations (PDF) October 16, 2003

CC-CG-002: Provider Complaint Process (PDF) June 11, 2015

PR-001: Service Authorization Procedures and Standards for Out-of-Network Providers (PDF) December 21, 2008

PR-005: Payment Authorization Procedures (PDF) October 19, 2017

PR-014: Assessment of Provider Cultural Sensitivity (PDF) February 22, 2018

Attachments

PR-015: Distribution of Medical Necessity Criteria to PerformCare Providers (PDF) February 22, 2018

PR-016: DHS Notification of Drop in Provider Capacity (PDF) March 28, 2018

PR-019: Processing Provider MA Enrollment Applications (Supplemental Services and Out of Network) (PDF) April 30, 2018

PR-020: Routine and Non-Routine Site Visits (PDF) April 30, 2018

PR-023: Advance Directives (PDF) May 8, 2018

PR-025: PerformCare Position on the Bundling of Psychiatric Services (PDF) May 8, 2018

PR-026: Provider Rate Setting (PDF) May 14, 2018

Attachments

PR-027: Interpreter Costs in Service Delivery (PDF) May 8, 2018

PR-028: Requirements for School-Based Outpatient Services (PDF) May 7, 2018

PR-029: Expansion Request Process for State Plan Service for Providers (PDF) May 23, 2018

PR-032: Provision of Reasonable Access to BHS Provided by FQHC Within Access Travel Guidelines (PDF) May 23, 2018

QI-006: Monitoring Plan for Service Transitions (PDF) October 24, 2018

QI-014: Member and Provider Satisfaction Surveys (PDF) October 24, 2018

QI-019: Provider Profiling Reports (PDF) August 7, 2018

QI-026: Provider Treatment/Service Record Reviews (PDF) August 10, 2018

QI-040: Evaluator Monitoring (PDF) October 1, 2015

QI-042: Six-Criteria Complaint Policy (PDF) August 22, 2018

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QI-043: Dissatisfaction Complaint Policy (PDF) August 22, 2018

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QI-044: Grievance Policy (PDF) August 22, 2018

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QI-CIR-001: Critical Incident Reporting (PDF) February 2, 2018

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QI-CIR-002: Sentinel Event Review (PDF) January 22, 2018

QI-CIR-003: Restraint and Seclusion Monitoring (PDF) January 22, 2018

Attachment

QI-CIR-001: Credentialing and Recredentialing Criteria Facilities (PDF) August 10, 2017

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QI-CR-002: Credentialing and Recredentialing Criteria Practitioners (PDF) February 25, 2020

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QI-CR-003: Credentialing Progressive Disciplinary Action for Providers (PDF) December 21, 2018

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QI-CR-005: Credentialing Committee (PDF) November 28, 2018

Attachment

QI-SIU-001: Development and Monitoring of Quality Improvement Plans (QIPs) Issued by the Special Investigation Unit (PDF) June 8, 2018

Attachments

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DHS notices, bulletins and clarifications