Provider Policies
Navigate directly to a letter:
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A
- ACT & CTT Authorization Requests (CM-053)
- Administrative Appeal Process (FI-027)
- Advance Directives for Adult Members (PR-023)
- Approval/Denial Process and Notification (CM-013)
- Assessment of Provider Cultural Humility and Awareness (PR-014)
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B
- BHT and BHT-ABA Skills, Training, and Development Payment Process (CM-CAS-059)
- Bed Hold Payment and Therapeutic Leaves for MH IP, RTF, and SU Non-Hospital Facilities (CM-019)
- Best Practice Evaluation (BPE) and Continued Care Eval Requirements (CM-CAS-055)
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C
- CRR-HH Authorization and Re-authorization Requests (CM-CAS-053)
- Clinical Care Management Decision Making (CM-011)
- Community Residential Rehabilitation Host Home (CRR-HH) Therapeutic Vacation (CM-CAS-050)
- Community Residential Rehabilitation-Host Home (CRR-HH) Pre-Discharge Planning Meeting Requirements (CM-CAS-048)
- Continued Stay Review Process for Services with Telephonic Review (CM-042)
- Credentialing Committee (QI-CR-005)
- Credentialing Progressive Disciplinary Actions for Providers (QI-CR-003)
- Credentialing and Re-credentialing Criteria - Facilities (QI-CR-001)
- Credentialing and Re-credentialing Criteria - Practitioners (QI-CR-002)
- Crisis Intervention Services Authorization Procedure (CM-MS-025)
- Critical Incident Reporting (QI-CIR-001)
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D
- DHS Notification of Drop in Provider Capacity (PR-016)
- Development and Monitoring of Quality Improvement Plans Issued by the Special Investigations Unit (QI-SIU-001)
- Dissatisfaction Complaint Process for Members (QI-043)
- Documentation Standards for Providers (QI-049)
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E
- Electroconvulsive Therapy (ECT) Requests for Initial, Continuation and Maintenance Electroconvulsive Therapy (ECT) Requests for Initial, Continuation and Maintenance (CM-045)
- Emergency Services-Coverage/Reimbursement (CM-034)
- Expansion Request Process for State Plan Service for Providers (PR-029)
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F
- FQHC Access for PerformCare Members (PR-032)
- Family Based Mental Health Services (FBMHS) Discharge Planning (CM-CAS-040)
- Family Based Mental Health Services (FBMHS) Prior to Discharge in a Residential Treatment Facility (RTF) or CRR-Host Home (CM-CAS-037)
- Family Based Mental Health Services (FBMHS) Procedure for Prior Authorization (CM-CAS-051)
- Family Based Mental Health Services (FBMHS) Procedure to Request Additional Service Units and Extension Requests (CM-CAS-044)
- Family Based Mental Health Services (FBMHS) and use of Family Support Services (FSS) (CM-CAS-041)
- Family Based Mental Health Services (FBMHS) in Conjunction with Targeted Case Management (TCM) (CM-CAS-038)
- Family Based Mental Health Services (FBMHS) in the Emergency Department (CM-CAS-036)
- Fraud Waste and Abuse Program (CC-002)
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G
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I
- IBHS Additions or Increasing Units During a Current Authorization (CM-CAS-062)
- IBHS Group, EBP, and Other Individual Services Authorization Requests (CM-CAS-043)
- IBHS Requests needing School, Daycare, and Other Community Program Input (CM-CAS-061)
- Individual IBHS and ABA Services Authorization Requests (CM-CAS-042)
- Individual Intensive Behavioral Health Services (IBHS) Concurrent Requirements with CRR-HH/CRR-ITP or RTF Prior to Discharge (CM-CAS-058)
- Inpatient Services Service Denial-Behavioral Health (CM-007)
- Inpatient and Partial Hospitalization (Mental Health) Programs Authorization Requests (CM-043)
- Inpatient and Residential Treatment Aftercare Referrals (CM-CAS-005)
- Intensive Behavioral Health Services (IBHS) Service Capacity and Referral Monitoring: Individual BC/MT/BHT & ABA Services – BA, BC-ABA Asst. BC-ABA/BHT-ABA (CM-CAS-060)
- Interpreter Cost Reimbursement Process (PR-027)
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M
- MA Enrollment Applications Processing (In Lieu of and in Addition to Services and Out of Network Enrollment for Provider) (PR-019)
- MH Outpatient Psychiatric Bundling of Services Expectations (PR-025)
- MH Outpatient School-Based Staffing Requirements (PR-028)
- Medical Necessity Criteria Distribution to PerformCare Providers (PR-015)
- Mobile Mental Health and Intellectual Disability (MH/ID) Requests for Initial and Continued Services (CM-054)
- Music Therapy Services Authorization and Delivery (CM-047)
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O
- Out-Of-Network Provider Authorization Procedures and Standards (PR-001)
- Outpatient Treatment Requests, Denials, and Authorizations (CM-MS-003)
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P
- Payment Adjustments for Provider-Preventable Conditions including Health Care-Acquired Conditions (CC-006)
- Payment Authorization Procedures for all Levels of Care (PR-005)
- Provider Audits Conducted by the Special Investigations Unit (CC-003)
- Provider Complaint Process (QI-045)
- Provider Dispute Policy (CC-005)
- Provider Notification to PerformCare of Inpatient Stays When Member has Other Primary Insurance (CM-020)
- Provider Profiling Reports (QI-019)
- Provider Transfer Process for Children’s Services (CM-CAS-057)
- Psychological and Neuropsychological Testing Authorization (CM-012)
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Q
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R
- RTF Authorization and Re-authorization Requests (CM-CAS-054)
- Rate Setting Process for all Levels of Care (PR-026)
- Recipient Verification of Services (CC-012)
- Reporting Suspected Provider Fraud, Waste and Abuse (CC-001)
- Residential Treatment Facility (RTF) Pre-Discharge Planning Meeting Requirements (CM-CAS-047)
- Restraint and Seclusion Monitoring (QI-CIR-003)
-
S
- Satisfaction Surveys for Members and Providers (QI-014)
- Sentinel Event Review Process (QI-CIR-002)
- Site Visits - Non-Routine (PR-020)
- Six-Criteria Complaint Process for Members (QI-042)
- Substance Use Disorder Services Authorization Requests (CM-028)
- Substance Use Hospital and Non-Hospital Based Withdrawal Management Authorization Requests (CM-029)
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T
- Targeted Case Management Contact Expectations (CM-039)
- Targeted Case Management Initial and Reauthorization Requests and Discharges (CM-036)
- Targeted Case Management Reimbursable and Non-Reimbursable Services (CM-037)
- Targeted Case Management Role Expectations (CM-040)
- Team Meeting and ISPT Meeting Expectations and Requirements for Children's Services (CM-CAS-056)
- Transcranial Magnetic Stimulation (TMS) Requests (CM-055)
- Treatment/Service Record Reviews (QI-026)
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U
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