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Policies and Notices

PerformCare policies and procedures

PerformCare policies posted to this website are updated semi-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.

Corporate compliance

•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

Attachments

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

Attachments

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

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

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

Attachment
Care management

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

•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

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

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

•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

•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

Attachments

•CM-048: Functional Behavior Assessment (FBA) (PDF) October 18, 2018

•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-CAS-052: FBMSHS Provided Concurrently with BHRS (PDF) October 23, 2018

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

Contact Center

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

Provider relations

•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

•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

Quality improvement

•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

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

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

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

Attachments

•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

Attachments

•QI-CR-002: Credentialing and Recredentialing Criteria Practitioners (PDF) December 21, 2018

Attachments

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

Attachments

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

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

Attachments

PerformCare provider notices

Administrative

2019

2018

2017

2016

2015

2014

2013

2012

2011

  • AD 11 109: Clarification of Payment Policy (PDF)
    Day of admission and day of discharge for inpatient services
  • AD 11 115: MA Bulletin 99-11-05 (PDF)
    "Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation"

2010

2009

2004

2002

Behavioral Health Rehabilitation Services (BHRS)

2019

2017

2016

2015

2014

2013

2012

2011

2010

2009

2007

Claims

2017

2016

2015

2014

2013

2011

2010

2009

DHS notices, bulletins and clarifications

2019
2016
2011 – 2015

2015


2014


2013


2012


2011

2006 – 2010

2010


2009


2008


2007


2006

2001 - 2005
1994 - 2000