Provider Operations Manual, Western Highlands Network, NC

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Provider Operations Manual

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Operations Manual

Operations Manual (11/30/07)

PDF (374K)

WHN Provider Manual

	Medicaid and State Funded Providers The absence of a designation (Medicaid or State Funded) means information or source applies to both types of providers

Section I	Provider Relations

	Technical Assistance, Training Collaboration
	www.westernhighlands.org/pr_training.htm

	Problem Resolution (Disputes and Appeals)
	Medicaid Provider - www.dhhs.state.nc.us/dma State Funded Provider - WHN website www.westernhighlands.org/pr_grievances.htm

	Who to Contact for Questions
	Medicaid Provider - DMA website www.dhhs.state.nc.us/dma State Funded Provider - WHN web site www.westernhighlands.org/contact.htm

	Notification of Change of Address
	Medicaid Provider - (USE DMA forms) www.dhhs.state.nc.us/dma State Funded Provider - Access procedures for changing address and contact information - WHN website www.westernhighlands.org/pr_registration.htm

Section II	*Comprehensive List of Requirements (new/updated grid)*
	For the Comprehensive List of Requirements please see the above WHN Provider Manual.

Section III	Authorization Process
	Medicaid Provider - www.dhhs.state.nc.us/dma Value Options - www.valueoptions.com/provider/contractspecific/ncmedicaid.htm State Funded Provider - WHN web site www.westernhighlands.org/pr_servauthprocedures.htm

Section IV	Claims

	LME fee collection policy and minimum fee/sliding scale fee schedules
	State Funded Provider - WHN web site www.westernhighlands.org/pr_reimbursement.htm

	Claims Filing Requirement
	Medicaid Provider - www.dhhs.state.nc.us/dma State Funded Provider - WHN web site www.westernhighlands.org/pr_reimbursement.htm

	Payment Schedule
	Medicaid Provider - www.dhhs/state.nc.us/dma State Funded - WHN web site www.westernhighlands.org/pr_reimbursement.htm

	Claims Adjudication
	Medicaid Provider - DMA web site www.dhhs.state.nc.us/dma State Funded - WHN web site www.westernhighlands.org/pr_reimbursement.htm

Section V	Provider Documentation Submission Requirements -
	Medicaid Provider - DMA web site www.dhhs.state.nc.us/dma For a listing of State Funded documentation requirements please review the Western Highlands web site under the specific area of interest - www.westernhighlands.org/forproviders.htm

Section VI	Quality Improvement & Performance Monitoring

	Provider Monitoring (AP surveys, reporting on Performance Indicators) www.westernhighlands.org/pr_performance.htm

	Client Rights Reporting
	http://www.dhhs.state.nc.us/mhddsas/manuals/#Forms www.westernhighlands.org/clientrights.htm

	Incident Reporting
	http://www.dhhs.state.nc.us/mhddsas/manuals/#Forms www.westernhighlands.org/pr_incident.htm

	Person-Centered Planning
	DMH - www.dhhs.state.nc.us/mhddsas WHN - www.westernhighlands.org/pr_crisisplan.htm

Section VII	*Area Authority-Specific Policies/Forms/Local Governance Requirements (not included elsewhere) - State Funded Providers*
	Please refer to the above full WHN Provider Manual for complete details A listing of all WHN Communication Bulletins can be accessed at www.westernhighlands.org/pr_commbulletins.htm

Section VIII	Glossary of Terms (Division and LME)
	A full listing of Glossary of Terms can be accessed within the above WHN Provider Manual

Section IX	Appendix of Resource List - Website - Council
	www.westernhighlands.org/links.htm