Community Care Behavioral Health Organization (CCBH) is a managed care organization for behavioral/mental health services through Medicaid funding. Other managed care organizations for behavioral health cover other counties. If a client has Medicaid, their mental health coverage goes through a managed care organization, in Centre County, this is CCBH.
Medicaid also has managed care organizations for physical health. If a client has any of the following insurances, it means they are Medicaid, and coverage for our services would likely be billed to CCBH:
Geisinger Family (GHP Family)
AmeriHealth/Caritas
UPMC For You
Highmark Wholecare
Health Partners Plan
Keystone First
United Healthcare Community Plan
CCBH/Medicaid have very specific and strict guidelines on documentation, they will audit, and if things aren't done the way they want, they will issue a corrective action plan and potentially request paybacks for services.
It is highly recommended that each provider who is credentialed with Medicaid read through the Provider Manual on the Community Care website.
It is very important that Sue is made aware of all Medicaid/CCBH clients before they are seen as an authorization* on file is required and they will need to be added to the Encounter Form*
*see below
Requirements for CCBH/Medicaid:
Authorization - each client must have an authorization on file for outpatient services; this is completed via the CCBH ePortal and can be requested 60 days in the past and 30 days in the future; auths last 365 days and are for 800 units (3.8 hours/week for 52 weeks), all hours do not have to be used. Sue will do authorization requests
Client signed encounter form - this is a form that's been created in SP, each Medicaid client is added to the form so the drop-down for the client's name will also include their Medicaid #, make sure to select the correct client;
Select "other document" in the progress note section of the client's chart
Choose "Encounter Form" from the drop-down
Select the correct client's name from the drop-down
Enter the date, time, and duration/units,
Sign the form
Send the form to the client for their signature
Once the form is signed by the client, it can no longer be unsigned or deleted
Encounter forms must be signed after the appointment time has ended
Treatment plans - all MA clients must have a treatment plan, make it easy on yourself and use the Wiley treatment planner within SP - don't overthink it
Psychotherapy Progress Note - use the note titled "Psychotherapy Progress Note" to save time for the following as each is required in a CCBH progress note:
Location of session
Risk assessment
Medical necessity criteria
Telehealth consent
Treatment Progress - make it easy on yourself and use the "treatment progress" section within the progress note, it automatically includes the progress in the appointment's progress note
CCBH operates in units instead of hours; 1 units = 15 minutes, 4 units = 1 hour
IMPORTANT:
since CCBH uses units and not hours, this means that the default for a session is 15 minutes (1 unit), this needs to be changed to 4 units within the appointment if doing a 1 hour/60-minute session
CCBH does not round up like commercial insurance, this means a 59-minute session gets billed for a 45-minute session (3 units); a 60-minute session has to be the full 60 minutes
Units change the billing/CPT codes:
Individual therapy: H0004 with modifier HB
Eval/initial session: H0004 with modifier HN
Family/Conjoint therapy: H0004 with modifier NR
SP does not allow for the same CPT code but with different modifiers so the Eval/Initial appt CPT is "H0004." (with the period); Family/Conjoint sessions have the CPT code as "H0004 ." (with the space and then period); these must be changed on the claim to remove the periods
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