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State of Michigan Medicaid Provider Manual and Medicaid Policy Bulletins

 

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
    5.    Customer 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View the Archive of out of date manuals.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 Customer Services Function
            5.1    Overview
            5.2    Customer Services Provider-Related Policies
                5.2.1    Consumer Orientation
                5.2.2    Limited English Proficiency, Accommodations Competencies and Cultural Competencies 
        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
            Glossary of Terms
            Supplement for Residential Care Providers
                 11.1     Group Home Curriculum Policy and Procedure
                 11.2     NFPA 101 1985 Life Safety Code
                 11.3     Appendix F - A Procedure for Determining Evacuation Capability
                 11.4     Evacuation Difficulty Score, Destination Training and Waiver Process
                 11.5     E-score Clarification of Requirements
                 11.6     Medications - Storage, Samples, Injectables, Disposal, Expirations and Recalls Policy and Procedure
                 11.7     Reporting Retention Guidelines for Fire and Smoke Related Events in Specialized Residential Group Homes
                 11.8     Smoke and Fire Incident Report
                 11.9     Annual Safety and Facility Assessment Form
                 11.10   Disposal of Sharps Guidelines
                 11.11   Group Home Safety Emergency Supply Kits
                 11.12   Lift Sling Training Letter
                 Ref. 01 Licensing Rules AFC Small Homes
                 Ref. 02 Certification Requirements for Specialized Programs
                 Ref. 03a MIOSHA Part 8 Portable Fire Extinguishers
                 Ref. 03b MIOSHA Part 69 Compressed Gases
                 Ref. 03c-03d-04a MIOSHA Part 42, 92, 430 and OSHA 29CFR 1910.1200 Hazard Communications
                 Ref. 04b OSHA 1910.157 Portable Fire Extinguishers - Training and Education
                 Ref. 05 Michigan Vehicle Code
                 Ref. 09 Michigan Fire Prevention Code              
     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


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Access Alliance of Michigan
A Division of Bay-Arenac Behavioral Health
201 Mulholland
Bay City, MI 48708
989-497-1302

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