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Illinois
Department of Human Services
Grace Hong Duffin, Acting Secretary
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Mental Health Provider Information
Provider Manual
FY11 DHS/DMH Community Mental Health Provider Manual
Table of Contents
I. INTRODUCTION
DHS/DMH Mission/Vision Statement
Philosophy of Recovery
Consumer and Family Handbook
Description of Role: Background, History, and Goals of the Illinois Mental Health Collaborative
II. PROVIDER ELIGIBILITY
DMH Community Services Contract-Attachment B
Medicaid Enrollment
Provider Enrollment
Chapter CMH-100
Chapter CMH-200 Children's Mental Health (SASS) (pdf)
Appendix (pdf)
Certification
Medicaid Community Mental Health Tool (MMH)
Forms to make Changes to Provider Database
Continuity of Care
Continuity of Care Agreement (FY11 content in development)
USARF for Adolescents (pdf)
USARF for Adults (pdf)
III. CONSUMER ELIGIBILITY AND ENROLLMENT
Consumer Eligibility, Enrollment and Benefit Status (pdf)
(New)
Functional Impairment Scales
Level of Care Utilization System (LOCUS)
Columbia Impairment Scale
Ohio Scales
Devereux Scale
IV. MENTAL HEALTH SERVICES
Service Definitions and Requirements
59 ILAC 132, Revised 07.01.2008
Service Definition and Reimbursement Guide, 07/01/2007 (pdf)
Revised Rule 132 Training Presentation (ppt)
Rule 132 Questions and Answers
PDA Day 2 Clinical Rehabilitation Training (pdf)
Utilization Management Program
Overview of UM Program (pdf)
Medical Necessity Criteria (FY11 Content in Development)
Capacity Grant, Definitions and Requirements
Definitions
DMH Community Services Contract-Attachment B
Forensic Services
Training Manual for Unfit to Stand Trial (UST) (pdf)
Revised Forensic Handbook (pdf)
Child Mental Health Services (SASS)
Chapter CMH-200 (Children's Mental Health/SASS) (pdf)
Appendix (pdf)
Pre-Admission Screening/Mental Health (PAS/MH)
PAS/MH Contractor's Procedure Manual (pdf)
V. PROVIDER MONITORING
Protocols (pdf)
Monitoring Tools
Post-Payment Review Tool (pdf)
Post-Payment Review Interpretive Guidelines (pdf)
Clinical Practice and Guidance Review Tool (pdf)
Clinical Practice and Guidance Review Anchors (pdf)
Clinical Practice and Guidance Review Interpretive Guidelines (pdf)
Plan of Improvement Template (doc)
Provider Complaints and Appeals
Medicaid-59 ILAC 132.44
Non-Medicaid Grants Recovery Process-59 ILAC 103.130
VI. CLAIMS SUBMISSION FOR COMMUNITY SERVICES
Going Online: Tools and Resources
ProviderConnect
ProviderConnect Users Guide (pdf)
ProviderConnect Helpful Resources
Pseudo-RIN Information(FY11 content in development)
Place of Service Crosswalk (pdf)
Service Modifier (pdf)
Service Matrix(FY11 content in development)
Collaborative Software
Direct Data Entry (pdf)
EDI Claims
Claim Line Separation Logic (xls)
Program Codes/Collaborative Software (pdf)
Third Party Software
Batch Registration (doc)
How to Submit Electronic Claims in HIPAA 837 Format
Illinois 837 Companion Guide (pdf)
Illinois 835 Companion Guide V2 (9/22/08) (doc)
HIPAA Advisory
Where to Learn More About HIPAA
Resources
PaySpan© Health: Healthcare Payment and Remittance Advice
(a free service to providers for EFT and ERA receipt)
Payformance PowerPoint Illinois (ppt)
PAS Mental Health
PAS/MH Contractor's Procedure Manual (pdf)
SASS claims (direct submission to HFS)
Chapter CMH-100, DHFS Handbook
Chapter CMH-200, DHFS Handbook
Chapter CMH-300, DHFS Handbook
VII. ICG
ICG Services Manual (doc)
ICG Claims (refer to claims section)
59 ILAC 135
Eligibility Criteria for the Individual Care Grant
Frequently Asked Questions - ICG
Appeals
Legal Aide Disabilities Guidebook - ICG
VIII. IMPORTANT REFERENCE AND RESOURCE DOCUMENTS
Illinois Statutes
Mental Health and Developmental Disabilities Confidentiality Act
Mental Health and Developmental Disabilities Code
Children's Mental Health Act of 2003 (pdf)
Important Federal Policies, Regulations, and Reports
Code of Federal Regulations (CFR)
United States Code (USC)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Surgeon General's Report on Mental Health, 1999
President's New Freedom Commission's Report on Mental Health, 2003
Accreditation Standards/Requirements
Commission on Accreditation of Rehabilitation facilities (CARF)
Joint Commission on Accreditation of Healthcare Organization
Council on Quality and Leadership (The Council)
Council on Accreditation of Services for Families and Children (COA)
Healthcare Facilities Accreditation Program
Illinois Provider Tools and Resources
Management Information System Resources Tool (pdf)
Evidence Based Practices:
Dartmouth IPS Supported Employment Center
SAMHSA Registry of Evidence Based Practices
Related Links
Q&A on FY 2011 Attachment B
Block Grant
Community Based Services (Rule 132)
Community Reporting System (ROCS)
DMH Team Members
Electronic Request for Recipient Identification Numbers (e-RIN)
Firearm Owners Identificiation Reporting
Frequently Asked Questions (FAQ)
Parker Dennison's Provider Monitoring Report
Parker-Dennison's Cost Restructuring Document
Policy Documents
Provider Manual
Provider Notices
Request for Services Plans (RSPs) and Proposals (RFPs)
Screening, Assessment and Support Services for Adult Recovery (SASSAR)
System Restructuring Initiative (SRI)
Transition to Collaborative MIS
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