REGIONAL CURRENT PROVIDER MANUAL - Complete (Printable) Version

State of Michigan Medicaid Provider Manual and Medicaid Policy Bulletins

Riverhaven Substance Abuse Coordinating Agency Provider Manual

Please click the link above to view or download the FY 08 Riverhaven Coordinating Agency Provider Manual.

CURRENT BEHAVIORAL HEALTH PROVIDER MANUAL- BY SECTION:

    1.    Introduction
    2.    Consumer Centered Care:  Our Core Values
    3.    Best Practice Guidelines
    4.    Access and Care Authorization Authorization
    5.    Member Services
    6.    Appeals and Grievances
    7.    Rights of Recipients
    8.    Administrative Requirements for Providers
    9.    Site Reviews
    10.  Claims and Reimbursement for Care
            Ability to Pay Policies and Procedures
    11   Supplement for Residential Care Providers
    12   Procedure and Billing Codes
    13   Provider Performance Requirements and Standards

View the Archive of out of date manuals.

Current Provider Manual - By Section

        1.    Introduction
            Mission, Vision, Values
            1.1    Summary of PIHP Role in Managed Behavioral Healthcare
            1.2    Key Functions of the PIHP
            1.3    General Information
                    1.3.1    Frequently Called Phone Numbers
                    1.3.2    Glossary of Terms
                    1.3.3    Index of Abbreviations
        2.    Consumer Centered Care:  Our Core Values
            2.1    Effective Freedom
            2.2    Person-Centered Planning
            2.3    Recovery and Relapse Prevention
            2.4    Employment
            2.5    Code of Ethics
        3.    Best Practice Guidelines
            3.1    Housing Best Practice Guideline
            3.2    Inclusion Best Practice Guideline
            3.3    Consumerism Best Practice               Guideline
            3.4    Personal Care Technical Requirement
            3.5    Person-Centered Planning Best Practice Guideline
        4.    The Access and Authorization Function
            4.1    The Role of the Access Department
            4.2    Access and Authorization System Overview
            4.3    Call Triage
            4.4    Target Population
            4.5    Eligibility, Enrollments and Initial Authorization
            4.6    Emergency Services
            4.7    Medicaid Health Plans (Formerly "Qualified Health Plans")
            4.8    The Authorization Process for Ongoing Services
                4.8.1    Authorization Types
                    4.8.1.1    Pre-Authorized Services
                    4.8.1.2    Authorized Services
        5.    The Member Services Function
            5.1    Overview
            5.2    Member Services Provider-Related Policies
                5.2.1    Consumer Orientation
                5.2.2    Limited English Proficiency and Accommodations Competencies
                5.2.3    Cultural Competency
        6.    Grievance and Appeal Technical Requirements
            6.1a    Appeal and Grievance Resolution Technical Requirement (Non Medicaid)
            6.1b    Appeal and Grievance Resolution Technical Requirement (Medicaid)
            6.2    Local Dispute Resolution Technical Requirement
            6.3    Provider Network Policy and Procedure:  Grievance and Appeal
        7.    Recipient Rights - Behavioral Health Services
            7.1    Full Policy and Procedure Set
            7.2    Rights Policies (Single Document Covering All Policies)
        8.    Other Administrative Requirements Applicable to All Providers
            8.1    Health Insurance Portability and Accountability Act (HIPAA)
                      Business Associate Agreement
            8.2    Clinical Documentation Policy
            8.3    Late Documentation Policy
            8.4    National Patient Safety Goals
                8.4.1    Prohibited and Dangerous Abbreviations Policy
        9.    Site Reviews
      10.    Claims Processing and Reimbursement Procedures
            10.1    Overview
            10.2    Claims Submission and Reimbursement
            10.3    HCFA 1500 Billing Instructions
             10.A    Ability to Pay Policy and Procedure
                    Financial Liability for Mental Health Services Policy/Procedure
                    Determining Ability to Pay (Adult, Non-Residential Recipients)
                    Determining Ability to Pay (Adult, Residential Recipients)
                    Determining Ability to Pay (Minors)
                    Ability Pay Fee Schedule
     11.    Supplement for Residential Care Providers
            11.1    Environment of Care Standards
            11.2    Procedures and Requirements for Criminal History Checks
            11.3    Personal Care Technical Requirement
            11.4    Residential Services Performance Standards/Site Review Template
     12.    Billings/Standard Procedure Codes
            12.1    Provider Encounter Reporting Codes,  Rounding and Other Rules
            12.2    HCPCS and Revenue Codes
     13.    Regional Provider Performance Standards (Site Review Templates)
            13.1    Master Protocol (Used by MDCH to review All Providers)
            13.2    Primary Care Performance Standards/Site Review Template
            13.3    Inpatient Care Performance Standards/Site Review Template
            13.4    Vocational Services Standards/Site Review Template
            13.5    Supported Independent Placements Standards/Site Review Template
            13.6    Residential Services Standards/Site Review Template   
 

Archive Provider Manuals:

        FY 2003-2004 Regional Behavioral Health Provider Manual

Access Alliance of Michigan
A Division of Bay-Arenac Behavioral Health
5455 Hampton Place
Saginaw, MI 48604
989-497-1302

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Last Update: 10/11/07