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Provider Online Services

Provider Handbook

The ValueOptions® Colorado Medicaid Provider Handbook serves as a supplement to the ValueOptions®  Participating Provider Handbook and provides a quick reference guide about policies and procedures specifically related to NBH Partnership.

Introduction

  • Welcome
  • General Information
  • Colorado Medicaid BHOs

Continuum of Services

  • Clinical Services Descriptions

Provider Assistance & Referrals

  • Clinical Operations
  • Customer Service Department
  • Network Credentialing
  • TeleConnect and ProviderConnect
  • Provider Availability and Access to Care Standards
  • Referrals
  • How Clients Access Behavioral Health Care

Utilization Management Procedures

Client Choice of Providers

  • Member Choice

Second Opinion

  • Second Opinions in a Disagreement with Treating Provider
  • Second Opinions in a Disagreement with a Notice of Action

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

  • Case Managers
  • Care Providers
  • How to Access EPSDT Services

Coordination of Care

  • Provider Responsibilities
  • Getting Member’s a PCP
  • Coordination with Other Agencies

Reviews, Reconsiderations and Appeals

  • Contacting Member and Family Affairs for Assistance
  • Clinical Guidelines
  • Peer Reviews
  • Requesting Reconsideration
  • Retrospective Authorization Process
  • Member’s Request for Appeal of an Action
  • Member’s Request for a State Fair Hearing
  • Continuing Services
  • Definitions
  • Designated Client Request Form

Network Credentialing

  • Credentialing and Recredentialing Standards
  • Contract Requirements
  • Credentialing Committees
  • Termination, Sanctions and Appeals
  • Change of address form

Benefits Summary

  • Colorado Medicaid Exclusions
  • Benefit Limits

Colorado Client Assessment Client Record (CCAR)

Billing for Services

Quality Improvement

Office of Member and Family Affairs

Transportation

  • Making Transportation Arrangements

Documentation Standards

  • General Requirements
  • Service/Treatment Plans
  • Progress Notes

Treatment Systems Level of Care and Diagnosis-Based Treatment Guidelines

Sample Clinical Forms