| Procedures |
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Access Fax Number
(828) 225-2782
OPENING PAPERWORK
is to be faxed to Western Highlands:
- STR
- Description of Consumer Clinical Issues
- LME Admission and Discharge Form (LCAD)
- Assignment of Case Responsibility/First Responder
- IPRS
- PCP (if requesting beyond Assessment)
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Word File |
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Utilization Management Fax Number
(828) 225-2779
ONGOING REQUESTS are to be faxed to the Services Management Department
- SAR
- PCP
- IPRS Updates
- CST/ACTT UR Forms
- Day Treatment/MST/IIH UR Forms
- Standardized Provider Submission re: Authorization of Room & Board Form
|
Word File
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| Instructions for Completing Notification Protocol Memo (12/05/04) |
Word File |
PDF |
| Instructions for ADATC Rehab Referral Form (04/27/09) |
Word File |
PDF |
| Notification Protocol (Rev. 12/05/03) |
|
PDF |
| Notification Protocol Memo (12/05/03) |
|
PDF |
| Transition of Consumers Procedure (01/25/08) |
Word File |
PDF |
| Unit of Service Cheat Sheet |
Word File |
PDF |
| Web Links for Notification Protocol (12/15/04) |
Word File |
PDF |
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| Communications |
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Bulletin #99 - 08/17/09
IPRS Benefit Changes
|
Word File |
PDF |
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Bulletin #88 - 12/23/08
Basic Benefit Package Adult/Child MH/SA
|
Word File |
PDF |
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Bulletin #87 - 08/22/08
Child Consumers Involved with Juvenile Justice
DJJDP Consultation - Quick Reference
DJJDP - Juvinile Justice Court Consultation
|
Word File
Word File
PPT
|
PDF
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Bulletin #75 - 01/25/08
Case Reponsible Transfer Procedure
This Bulletin Supercedes#33 |
Word File |
PDF |
Consumer Transfer and Notification Consent Form 01/25/08
|
Word File |
PDF |
Bulletin #41 - 06/12/06
14-Day Limit on Pended Service Authorization Requests |
Word File |
PDF |
Bulletin #38 - 06/06/06
Clarification of Service Authorizations for Individuals with Out of County Medicaid |
Word File |
PDF |
Bulletin #31 - 03/30/06
Medicaid Authorization Process during transition to state-wide vendor |
Word File |
PDF |
Bulletin #27 - 03/08/06
Medicaid & IPRS Letter of Notification Protocol |
Word File |
PDF |
| |
| Service Authorization Requests |
| Services REQUIRING Authorization Effective (11/01/05) |
Word File |
PDF |
| Services NOT Requiring Authorization Effective (11/01/05) |
Word File |
PDF |
| Service Authorization Tracking Sheet (06/13/05) |
Word File |
PDF |
| Description of the Initial Clinical Evaluation (9/01/04) |
Word File |
PDF |
| Value Options Forms |
Value Options forms can be obtained from their website at: www.valueoptions.com.
From their home page, select "For Providers", then select "Regional Focus", then select "North Carolina Medicaid Account." |
| Service Authorization Codes and Service Definitions |
| Adult Service Authorization (01/12/05) |
Word File |
PDF |
| Child and Family Service Authorization (04/01/05) |
Word File |
PDF |
| DD Service Authorization (01/12/05) |
Word File |
PDF |
| Substance Abuse Service Authorization (01/12/05) |
Word File |
PDF |
| Specialized Adult Services and Substance Abuse Programs (02/17/05) |
Word File |
PDF |
| Description of Coding for Crisis Intervention (09/11/04) |
Word File |
PDF |
| APSM 1026 Service Definitions Manual (01/03) |
|
PDF (2 Mb) |
| APSM 45 Service Records Manual (09/03) |
|
PDF (440 Kb) |
| Substance Abuse Service Definitions |
Word File |
PDF |
| Utilization Review |
| Adult Services Utilization Review Narrative (02/09/06) |
Word File |
PDF |
| Entitlement Resources (7/20/05) |
Word File |
PDF |
| Provider Responsibility for Conducting Utilization Review (09/01/04) |
Word File |
PDF |
| Standard Care Guidelines (Grids) for Disability Areas and Levels of Care |
| Adult Mental Health and Substance Abuse - State Funded Grid (10/19/09) |
Word File |
PDF |
| Child Mental Health and Substance Abuse - State Funded Grid (10/09/09) |
Word File |
PDF |
| Developmental Disabilities - State Funded Grid (10/16/09) |
Word File |
PDF |
| Developmental Therapy Excess Unit Override Instructions (07/11/07) |
Word File |
PDF |
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