Gila River Health Care Corporation
Gila River Health Care Corporation
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Arizona Department of Health Services

Division of Behavioral Health Services
PROVIDER MANUAL
Gila River Regional Behavioral Health Authority Edition


Section 14 Provider Manual Index

834 Transaction Enrollment/Disenrollment 7.5

A                                                                                                                                                                             

Abuse and neglect

2.0, 3.9, 4.1, 5.3, 7.4

Abuse, child

4.1, 5.3

Abuse, fraud and

7.1, 7.4, 7.5, 9.1

Access to care

2.0, 3.14, 8.4

Accreditation

3.20, 4.1, 8.5

Action

5.2, 5.1, 5.5

Action, civil court

3.18

Action, Notice of

3.9, 3.14, 5.1

Administrative hearing

5.3, 5.5, 5.6

Administrative Office of the Arizona Supreme Court (AOC)

4.4

Adult Clinical Team

3.14, 3.17, 3.22

Adult Consumer Survey

8.3

Adult Protective Services

3.20, 4.1

Advance Directive

3.12, 4.2

Adverse drug reaction

3.15

Alcohol and Drug Abuse Program

4.1

American Indian Tribal Member

3.18

Annual update

3.7, 3.9, 7.5

Appeal, member

5.1, 5.5

Appeal process

3.9, 3.10, 3.20, 4.1, 5.1, 5.2, 5.5

Application for voluntary evaluation

3.11, 3.18, 4.2

Appointment standards

3.2, 3.3, 3.9, 3.15, 3.17, 3.19, 4.3, 4.4

Arizona Center for Disability Law

4.1, 4.2, 7.3, 7.4

Arizona Children’s Principles

2.0

Arizona County jails

4.4

Arizona Department of Corrections (ADOC)

3.2, 3.3, 3.8, 3.19, 4.1, 4.4

Arizona Department of Economic Security/Division of Children, Youth and Families (DES/DCYF)

3.3, 3.8, 4.4, 5.1, 9.1

Arizona Department of Economic Security/Rehabilitation Services Administration (DES/RSA)

4.4

Arizona Department of Education (ADOE)

3.3, 3.22, 4.4

Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) Covered Behavioral Health Services Guide

3.1, 3.2, 3.4, 3.9, 3.13, 3.16, 3.19, 3.21, 3.22, 7.5

ADHS/DBHS Demographic Data Set User Guide

7.5

ADHS/DBHS Medication Formulary

3.16

ADHS/DBHS Pharmacy and Therapeutics Committee

3.16

Arizona Department of Health Services/Office of Assisted Living

4.4

Arizona Department of Juvenile Corrections (ADJC)

3.3, 4.4

Arizona Early Intervention Program (AZEIP)

4.4

Arizona Families F.I.R.S.T. Program
*Arizona Health Care Cost Containment System (AHCCCS)
*AHCCCS Administration (AHCCCSA)
*AHCCCS application for health insurance
*AHCCCS health plans
AHCCCS behavioral health coordinator
AHCCCS identification number
AHCCCS Office of Program Integrity
Arizona Long Term Care System (ALTCS)
ALTCS program contractor
Assessment
Auricular acupuncture services

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B                                                                                                                                                                             

Balanced Budget Act (BBA)

8.4, 9.1

Behavioral health category assignment

3.10, 3.17, 7.5, 9.1

Behavioral health disorder

3.8, 3.10, 3.15, 4.3, 9.1

Behavioral health medical practitioner

3.9, 3.11, 3.15, 3.16, 4.3

Behavioral health medical records

4.1, 4.2

Behavioral health professional

3.7, 3.14, 3.20, 5.2

Behavioral health related field

3.20

Behavioral health technician

3.7, 3.20

Benchmark 8.3

Billing requirements

3.5

C                                                                                                                                                                             

Case management

3.4, 3.9, 3.10, 3.19, 5.5

Center for Mental Health Services (CMHS)

3.19

Centers for Medicare and Medicaid Services (CMS)

3.20, 7.3, 7.4, 8.4

Certification

3.20

Certification of Need (CON)

3.14, 4.2

Chemical Database Service (CDS)

3.20

Child abuse and neglect reporting

4.1, 7.6

Child and Family Team

3.2, 3.14, 3.17, 3.22, 4.4, 9.1

Child Protective Services (CPS)

2.0, 3.2, 3.3, 3.9, 3.11, 4.1, 4.4, 9.1

Civil court action 3.18
Claim 6.1

Claim dispute

5.6

Claim submission timeframe

6.1

Clean claim

6.1, 6.2

Client Information System (CIS)

2.0, 6.2, 7.5, 8.1

Client rights

3.6, 3.9, 3.10, 3.12, 4.1, 5.2, 5.3, 5.4, 5.5, 9.1

Clinical formulation and diagnosis

3.9

Clinical Guidance Documents

2.0, 9.1

Clinical Team

3.2, 3.8, 3.14, 3.17, 3.22, 4.1

Closure

3.8

Coinsurance

3.5, 6.1

Commonly Encountered LEP Groups 3.23

Communicable disease information

4.1

Community Mental Health Services (CMHS) Performance Partnership

2.0, 3.21

Community Service Agencies (CSA’s)

4.2, 9.1

Competent professional

4.1

Complaint

5.1, 5.2, 5.5

Complaint process

5.1, 5.2

Comprehensive clinical record

3.1, 3.4, 3.7, 3.8, 3.9, 3.10, 3.11, 3.14, 3.15, 3.17, 3.18, 3.19, 3.22, 4.2, 5.1, 5.4, 5.5, 7.3

Computation of time

5.1, 5.5

Confidential information

3.8, 4.1

Confidentiality

3.8, 4.1, 5.2, 5.3, 5.4, 9.1

Consent to treatment

3.9, 3.11, 3.15, 4.2

Consumer and Family Satisfaction Survey

8.3

Consumer Surveys

8.3

Continuity of care

3.8, 3.9, 3.14, 5.1

Contract year

3.17, 4.3, 7.2

Co-occurring substance abuse

3.10, 7.5

Coordination of benefits

3.1, 3.4, 3.21, 3.5, 9.1

Coordination of medical care

4.3, 3.7, 3.15, 3.22

Coordination of services

3.7, 4.4

Co-payments

3.4, 3.5, 3.21, 7.2

Co-payments, how determined

3.4

Core assessment

3.9, 4.2

Corrective Action Plan (CAP)

5.2, 5.3

Cost avoidance

3.5

Cost sharing responsibilities

3.5, 3.21

Court-ordered disclosure

4.1

Court-ordered evaluation

3.8, 3.17, 3.18, 4.1, 4.2

Court-ordered treatment

3.17, 3.8, 3.18, 4.2

Covered Behavioral Health Service Guide

3.1, 3.2, 3.4, 3.9, 3.13, 3.16, 3.19, 3.21, 3.22, 7.5

Covered entity

4.1

Credentialing and Privileging

3.20, 8.4

Crisis episode

3.8, 6.1, 7.5

Crisis services

3.2, 3.4, 3.17, 3.21, 9.1

Cross-tapering

3.15

Cultural competency

2.0, 3.23, 9.1

Cultural considerations

3.22

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D                                                                                                                                                                             

Danger to Others (DTO)

3.8, 3.18, 9.1

Danger to Self (DTS)

3.8, 3.18, 9.1

Dangerous

3.11, 5.3

Data submission

3.2, 3.4, 3.8, 3.9, 3.10, 3.17, 3.19, 4.2, 7.5, 9.1

Deceased persons

3.8, 4.1

Deductible

3.5, 3.21

Definitions

11.00

Delivery of notices and appeal decisions

5.5

Demographic data

7.5, 9.1

Denial

3.5, 3.10, 3.14, 3.21, 4.1, 5.1, 5.2, 5.5, 5.6

Department of Economic Security/Department of Children, Youth and Families (DES/DCYF)

3.3

Designated Representative

3.12, 3.15, 4.1

Designated T/RBHA

3.17

Developmental disability

3.20

Disability

3.23

Discharge planning

3.7, 3.22, 7.2

Disclosure of behavioral health information

4.1

Disclosure of records

4.2

Disenrollment 7.5

Division of Developmental Disabilities (DDD)

4.4

Domestication or Recognition of Tribal Court Order

3.18

Drug Enforcement Administration (DEA)

3.20

Drug used as a restraint

7.3

Dual eligible

3.5, 3.13, 3.16, 3.21, 7.2

 

E                                                                                                                                                                             

Elderly or Physically Disabled (EPD)

3.8, 7.5

Electro-Convulsive Therapy (ECT)

3.11

Electronic data submission 7.5

Eligibility determination

3.1, 3.4

Eligibility screening and supporting documentation

3.3

Eligibility Verification System (EVS)

3.1

Emancipated minor

4.1

Emergency admission 3.18

Emergency behavioral health services

3.14

Emergency medical services

4.3

Encounter

6.1, 6.2

Encounter validation studies 8.1

Engagement

3.8

Enrollment, disenrollment and other data submission 7.5

Expedited appeal

5.1, 5.5

Explanation of Benefits (EOB)

5.1

Extension

3.10, 4.2

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F                                                                                                                                                                             

Family member

4.1

Federal Poverty Guidelines

3.4

Fee-for-service

6.1

Final disposition

3.3

Fixed dollar amount

3.4

Flex Funds

3.13

Follow-up after hospitalization

8.4

Forms

13.0

Formulary

3.16

Fraud and abuse 4.1, 5.2,  , 5.6, 7.1


G                                                                                                                                                                             

General Mental Health (GMH)

3.4, 7.5

Geographic Service Area (GSA)

3.21

Global Assessment of Functioning Scale (GAF)

3.9, 3.10

Gravely Disabled (GD) 3.18

Grievance

4.1, 5.2, 5.3, 5.4, 5.5


H                                                                                                                                                                             

Habilitation providers

4.2

Health care decision-maker

4.1

Health care power of attorney

3.11, 3.12, 4.1

Health care professional

5.1, 5.2, 3.3

Health Insurance Portability and Accountability Act (HIPAA)

4.1, 7.5

HIV Early Intervention Services

3.19

HIV information

4.1

Home T/RBHA

3.17

Homeless

3.8, 3.19

Homeless offenders

3.19

Housing and Urban Development (HUD,) United States Department of

3.4

Human rights advocates

5.4

Human Rights Committee (HRC)

4.1, 5.4, 7.3

Human rights violation

5.4, 7.4

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I                                                                                                                                                                             

Identification cards

4.1

Illegal

5.3

Immediate response

3.2

Incapacity

4.1, 7.4, 7.6

Incident or accident

7.4

Independent case review

8.2

Independent Case Review (ICR) Tool

8.2

Independent living setting

3.17

Indian Health Service (IHS)

4.3

Individual

4.1

Individual Education Plan (IEP)

4.4

Individual Service Plan (ISP)

3.17

Information sharing

3.11, 4.1

Informed consent

3.11, 3.15, 4.2, 8.4

Inhumane

5.3

Initial notification and periodic updates

3.22

Injection drug abusing populations

3.19

Inpatient services

3.14, 4.3

Institution for Mental Disease (IMD)

3.17, 3.21, 7.2

Institutionalized individual

3.21

Intake

3.9

Intake, Assessment and Service Planning

3.9

Interactive Voice Response (IVR) System

3.1

Interagency Service Agreement (ISA)

4.4

Inter-class polypharmacy

3.15

Intergovernmental Agreement (IGA)

4.4

Interim service plan

3.9

Interpretation 3.23

Interpretation services

3.4, 5.1, 5.5

Inter-T/RBHA transfers

3.8, 3.17

Intra-class polypharmacy

3.15


K                                                                                                                                                                             

KidsCare

3.1, 3.21, 7.2

L                                                                                                                                                                             

Level I behavioral health facility

3.5, 3.8, 3.12, 3.14, 4.3, 7.2, 7.4

Level II behavioral health facility

3.14, 4.3

Level III behavioral health facility

4.3

Licensing

3.20

Limited authorization

5.1, 5.5

Limited English Proficiency

3.23

Limited Income Subsidy Program (LIS)

3.1, 3.5, 3.16, 3.21, 7.2

Linguistic competency

2.0, 3.23

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M                                                                                                                                                                            

Managed Care Organization (MCO)

4.3, 8.4

Mechanical restraint

7.3

Medical Care Evaluation Studies

8.5

Medical detoxification

3.11

Medical Electronic Verification Services (MEVS)

3.1

Medical Institution

3.21

Medical records

3.11, 3.15, 4.1, 4.2, 4.3

Medically necessary covered services

3.13, 3.14

Medicare Advantage Prescription Drug Plan (MA-PD)

3.1, 3.5, 3.13, 3.16, 3.21, 7.2

Medicare fee-for-service

3.5

Medicare Modernization and Improvement Act

9.1

Medicare Part D Prescription Drug Coverage

3.1, 3.5, 3.13, 3.16, 3.21, 7.2, 9.1

Medication errors

3.15

Medication formulary

3.16

Medications, high risk

3.15

Member appeal

5.1, 5.5

Member complaints

5.2

Member handbooks

3.6

Memorandums of Understanding (MOU)

4.4

Mental disorders

3.10, 3.18

Mental health care power of attorney

3.12

Mental Health Statistics Improvement Program (MHSIP)

8.3

Methadone, courtesy dosing of

3.17

N                                                                                                                                                                             

National Practitioner Data Bank (NPDB)

3.20

National Provider Identifier (NPI)

3.20

Natural Support

3.9

Non contracted provider services

3.14

Non-QMB dual

3.5

Non Title XIX/XXI

1.0, 6.1, 6.2, 7.5

Notice and appeal requirements

5.1, 5.5

Notice of Action

3.14, 3.9, 5.1

Notice of decision and right to appeal

3.9, 5.5

Notice of SMI Grievance and Appeal Procedure

3.9, 5.5

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O                                                                                                                                                                             

Office of Behavioral Health Licensure (OBHL)

4.2, 7.4

Office of Civil Rights (OCR)

4.1

Office of Human Rights

5.4, 7.3

One time consultation

3.8

Outreach activities

3.8

Outreach, Engagement, Re-Engagement and Closure

3.8

Out-of-area service

3.17

Out-of-home placements

3.22

Out-of-network referral

3.5

Out-of-network services

3.5, 5.1

Out-of-state placements

3.22

P                                                                                                                                                                             

Path to Assist the Transition from Homelessness (PATH) Program

3.19

Performance Improvement Project

3.11, 8.4

Persistently or Acutely Disabled (PAD) 3.18

Personal restraint

7.3

Pharmacy and other physician ordered services

3.5

Polypharmacy

3.15

Post-payment recovery

3.5

Post stabilization services

3.21

Powers and duties of designee(s)

3.11

Pre-Admission Screening and Resident Review (PASRR)

5.1, 5.5

Pregnant women

3.19

Pre-petition screening 3.18
Prescriber 3.15

Prescription Drug Plan (PDP)

3.16

Primary care physician/provider (PCP)

3.2, 3.3, 3.9, 3.12, 3.15, 4.2, 4.3

Primary source verification

3.20

Principles for Persons Determined to Have a Serious Mental Illness

2.0

Prior authorization

3.5, 3.14, 3.16, 3.22, 5.1, 5.5

Procedures for filing claim disputes

5.6

Protected health information

4.1

Provider network

3.20

Provider directories

3.3

Prudent Layperson

3.14

Pseudo identification number

6.2

Psychiatric acute hospital

3.14

Psychiatric consultations

4.3

Psychiatric evaluation

3.2

Psychiatrist

3.10, 3.14, 4.1

Psychotic diagnoses

3.10

Psychotropic medications

3.2, 3.3, 3.8, 3.9, 3.11, 3.15, 4.2, 4.4, 4.3, 8.4

Punitive action

5.1

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Q                                                                                                                                                                             

QMB dual

3.5

Qualified clinician

5.5

Qualified service organization

4.1

Qualified service provider

3.14

Quality Management (QM)

3.14, 3.20, 4.2, 7.5, 8.4, 8.5

Quality of care

5.2, 8.4, 8.5


R                                                                                                                                                                             

Re-certification of Need (RON)

3.14, 4.2

Recredentialing

3.20

Redisclosure

4.1

Reduction of service

5.5

Re-engagement

3.8

Referral process

3.3

Referrals for hospitalized persons not currently T/RBHA enrolled

3.2

Regional Treatment Centers (RTCs)

7.2

Regional Vocational Service Plan

4.4

Reporting, child abuse and neglect

4.1

Reporting of incidences, accidents and deaths

7.4

Reporting requirements

3.1, 3.15, 3.5, 7.2

Reporting to Office of Behavioral Health Licensure (OBHL)

7.3

Reporting to Office of Human Rights

7.3

Request for investigation

5.3, 5.4, 5.5

Residence

3.17

Residential Treatment Center (RTC,) Level I

3.14, 3.21

Resolution process

5.3

Restraint

7.3

Resubmitting denied claims

6.1

Retention of records

4.2

Retro-eligibility claim

6.1

Revocation of informed consent

3.11

Risk Assessment – Mental Status Examination

3.9

Room and board

3.4

Routine response

3.2

S                                                                                                                                                                             

Sanction

6.2

Screening for Title XIX/XXI eligibility

3.1

Seclusion and restraint

7.3, 8.4

Securing services and Prior Authorization

3.14

Serious injury

7.4

Serious mental illness (SMI)

3.10, 3.15, 3.17, 3.21, 5.5

SMI Eligibility Determination

3.10

Serious occurrence

7.4

Seriously Emotionally Disturbed Child (SED) 7.5

Service authorization request

5.1

Service codes

3.9

Service plan

3.9, 3.22

Service prioritization

3.21

Service prioritization for Non-Title XIX/XXI Funding

3.21

Services for women with young children

3.19

Sexually Violent Persons (SVP) Program

4.1

Single case agreement

3.14, 3.22

Social Security Act (SSA)

7.2

Special assistance for members enrolled as SMI

5.4

Special populations

3.2, 3.19

Special requirements for children

3.11

Specified Low-income Medicare Beneficiaries (SLMB)

3.21

State Children’s Health Insurance Program (SCHIP)

4.3

State fair hearing process

5.1

Sub-acute facility

3.14

Subcontractor

3.19, 4.1

Submitting claims and encounters

6.1, 6.2

Substance Abuse and Mental Health Services Administration (SAMSHA)

2.0, 3.19

Substance Abuse Prevention and Treatment Block Grant (SAPT)

2.0, 3.2, 3.3, 3.19, 3.21

Support services

2.0, 3.4, 4.4, 3.13, 3.17, 3.19, 3.22

Supporting documentation

3.3

Suspension of service

5.5

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T                                                                                                                                                                             

Team

3.9

Telemedicine

3.11, 4.2

Termination of services

5.5

Therapeutic foster home

4.2, 9.1

Third party liability

3.5

Third party payer

3.5

Timeliness of service

3.2, 3.9

Traditional healing services

3.4

Training requests

9.1

Training requirements

3.20, 9.1

Transfer

3.17

Transition from child to adult services

3.17

Transition of care

3.17

Transition of payers

3.17

Transition of persons

3.17

Translation 3.23

Transportation

3.5, 3.17, 4.3

Tribal/Regional Behavioral Health Authority (T/RBHA) specific requirements

See Section 10.0 of T/RBHA Provider Manual

Tribal Sovereignty in the United States 3.18


U                                                                                                                                                                             

Unemancipated minor

4.1

Urgent response

3.2

Utilization review

3.14, 8.1, 8.4, 8.5


V                                                                                                                                                                             

Vocational services

3.19

Voluntary evaluation

3.11, 3.18

Voluntary treatment 3.18


W                                                                                                                                                                            

Wait list

3.2, 3.19

Waiting times

3.2

Working day

5.1


Y                                                                                                                                                                             

Youth Services Survey for Families

8.3

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14 Provider Manual Index
Last Revised: 07/22/2011
Effective Date: 09/01/2011

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