The LifeWays Provider Manual is included in the contract between LifeWays and service providers in the areas that are applicable to their service delivery, and outlines expected standards of care.
The information herein is subject to change at any time by LifeWays' action. LifeWays will make every effort to keep changes to a minimum to avoid unnecessary burden for providers. Changes will be communicated to service providers through the 30-day process for obtaining comment.
The Provider Manual is offered in Adobe (pdf) format and you will need Adobe Reader to open and view.
A brief description of the section is provided below.
Section 1. Introduction to LifeWays
Includes: LifeWays overview and its role as the CMHSP; LifeWays' Mission, Vision, and Values; LifeWays' Organizational Chart; LifeWays' Strategic Plan; Committees; Corporate Compliance; Public Relations; Overview of LifeWays' Provider Network Services
Section 2. Provider Network
Includes: Provider Network Membership; Provider Network Contract Management; Provider Network Credentialing; Provider Relations; Accreditation Requirements.
Direct links to forms:
CARF Requirements for Unaccredited Providers
Section 3. Recipient Rights
Includes: Role of the Office of Recipient Rights; Reporting Recipients Rights Violations; What to Expect During a Recipient Rights Investigation; Recipient Rights Training Requirements; Critical Incident Reports; Recipient Rights Advisory Committee; Appeals/Appeals Committee; How to Contact Recipient Rights; Policies & Procedures.
Section 4. Customer Services
Includes: Customer Services; Consumer Handbook; Consumer Advisory Council; Limited English Proficiency (LEP); Grievance and Appeal; Meeting Room Requests.
Section 5. Utilization Management (UM)
Includes: Role of the UM Department; Services Authorized by the UM Department; Eligibility; Medical Necessity; Level of Functioning; Level of Care; Service Authorization Process; Transferring and Closing Cases; Inpatient Treatment/Alternative Treatment Orders; Case Consultation; Under and Over Utilization; Utilization Review Committee; UM Policies & Procedures.
Section 6. Clinical
Includes: Policies & Procedure From the Clinical Services Division, Related to Evidence-Based Practice; Clinical Risk Management; System of Care.
Section 7. Service Descriptions
Includes: Descriptions of All Services Found in the Medicaid Provider Manual Under Sections of Mental Health/Substance Abuse.
Section 8. Access
Includes: Information Related to Role of the Access Department; Access Overview; Initial Authorization of Services; Priority Population; Waiting Lists; Consumer Choice; Access Policies & Procedures.
Section 9. EMR - Updated 5/23/17
Includes: Role of the IT Department; LEO Overview; Provider Access and Permissions; Provider LEO Training; EMR Quality and Integrity Standards; Data Requirements; Help Desk; LEO Bulletins; System Enhancements and Recommendations; Security and Protection of PHI; Release of Information; Meaningful Use; CEHR Portal/Consumer Access to Medical Records; Business Continuity; Transition to ICD-10 and DSM-5
Section 10. Quality Services
Includes: Role of the Quality Department; Quality Improvement Plan; Strategic Planning; Performance Monitoring; Stakeholder Input; Accreditation; Regulatory Compliance; Service Fidelity and Outcomes Monitoring; Process Improvement; Sentinel Event and Root Cause Analysis; Technical Requirement and Practice Guidelines; Quality Improvement Council.
Attachment: How to Generate BH-TEDS Records (BH-TEDS User Manual)
Section 11. Claims
Includes: Claims Submissions; Paper Form HCFA 1500 or UB04; Electronic Claims via LEO or 837 File; System Disaster Recovery; Timeliness of Submissions; Clean Claims; Authorization for Secondary Coverage; Remittance and Payment Schedule; Fee Determination; Family Support Subsidy Program; LifeWays Operating Procedures 3-04.05 Family Support Subsidy Program and 3-04.09 Ability to Pay.
The following is a list of forms not available on LEO as well as commonly used forms and resources:
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