Integrated Delivery System (IDS) Handbook

Integrated Delivery System (IDS) Handbook

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Integrated Delivery System (IDS) Handbook The Integrated Delivery System (IDS) Handbook sets forth the standards for the IDS Agencies. For more information about the IDS, please click here. The IDS Handbook is currently being revised for 2013. Please check with CAPS to ensure you have the most updated policy. Some files are available in PDF. To view these files, you will need Adobe Reader.   The IDS Handbook is divided into four sections, Overview, Administrative, Clinical, and the Appendix. To jump to one of these sections, please follow the links on the left. Cover Table of Contents I. Overview Fee for Service System Overview  Mission and Goals  Integrated Delivery System (IDS) Connection with the Mid-Valley Behavioral Care Network (MVBCN) Integrated Delivery System (IDS) Committees OHP Member Grievance Process: Complaints, Actions, Appeals, and DHS Administrative Hearings , Member Complaint Form, MVBCN Complaint Process  and MVBCN Grievance System: Complaints, Notices of Action, Appeals, Expedited Appeals, and DHS Administrative Hearings Policy  Declaration for Mental Health Treatment and the Declaration for Mental Health Treatment Guide Emergency Preparedness II. Administrative Access and Screening Requirements  Agency Admissions  Oregon Health Plan (OHP) Access Reporting  Reporting Available Appointments and Reporting Available Appointments Form Community and Provider Services (CAPS) Website  Technical Assistance Clinician Qualifications/IDS Request Form for a New Provider and Obtaining NPI Identifiers and IDS New Practitioner Form UPDATED 11/01/12  Checking Oregon Health Plan (OHP) Member Eligibility in the Mid-Valley Independent Physician’s Association (MVIPA) Website  Initial Authorization Process  Retro Authorization Process  Special Needs/Equipment Requests  Secondary Authorization Process UPDATED 08/01/12 and Secondary Authorization Referral Form UPDATED 08/01/12 Terminating In-Panel Authorizations Agency Discharge/Terminations  Integrated Delivery System (IDS) Client Appointment Policy  Member Transfers Between Integrated Delivery System (IDS) Providers and Member Transfer Form Authorizations for Out-of-Panel Services  Second Opinion Requests from Members  Cross County Reconciliation Integrated Delivery System (IDS) Service and Encounter Data Requirements  Client Processing Monitoring System (CPMS)  Integrated Delivery System (IDS) Provider Reports, Sample Provider Report,  Sample $0 Cost-to-Date Report, and Sample Access Data Report Claims and Authorization Reports 2012 Financial Model  REVISED 1/1/2012 Reconciliation Audit and Clinical Record Review Form Definition of “Out of Clinic” and Scenario Matrix Agency Fee Schedules  Integrated Delivery System (IDS) Provider Refund and Payback Process  Certificate of Approval Peer-to-Peer Services Cultural Sensitivity & Consumer Driven Services and Visual Review Tool Fraud & Abuse III. Clinical Clinical Expectations When Providing Service to Oregon Health Plan (OHP) Enrollees  Medically Necessary Determinations, Mental Health Continued Service/Transfer/Discharge Criteria, Adolescent & Adult/Level-of-Care Summary, Child Needs List/Level-of-Care Summary  Co-Occurring Mental Health and Substance Use Disorders  Dual Enrollment Within a Single Agency for Chemical Dependency and Mental Health Services  Evidenced Based Practices and Utilization Review for Evidence Based Practices Trauma Sensitive Services, The Relationship of Adverse Childhood Experiences to Adult Health: Turning Gold into Lead and Utilization Review for Trauma and Other Co-Occurring Disorders Crisis and Hospital Services Interpreter Services New Solutions – Services and Authorizations  Transitional Options and Treatment Alternatives (TOTAL)  Safe Treatment Alternatives for Youth (STAY)  Work Solutions and Skills Training Enhancement Program (STEP) Authorizations  Early Assessment and Support Team (EAST) Consumer Care Partnerships (CCP) and the Consumer Care Partnerships Request Form Trauma Survivor Project (TSP) and the Trauma Survivor Peer Support Request Form Chemical Dependency Services IV. Appendix Glossary of Terms & Acronyms IDS Reimbursement Schedule REVISED 07/15/12  Code Conversion Guide – MHO Code Conversion Workgroup, Developed for use by Oregon MHO’s  Oregon Health Plan Mental Health Medicaid Procedure Code and Reimbursement Rates for Services Mid-Willamette Regional Acute Care Units and Mid-Willamette Community Mental Health Programs 2005-2007 Linkage Agreement  Numerical Listing of DSM-IV Diagnoses and Codes (hard copy only) Mental Health Care and Chemical Dependency Services  Mental Health Care and Chemical Dependency Services New Practitioner Form NEW 11/01/12 Community & Provider Services (CAPS) 2421 Lancaster Dr NE, Salem, OR 97305 (503) 585-4977 fax (503) 361-2782

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