GCCMH will no longer accept a separate physicians order written on a prescription paper along with a Request for Consult.
Here is the new procedure for GCCMH accepting Request for Consults(RFC):
GCCMH will only accept a RFC from this point forward with the diagnosis and all services checked including the specific need listed under each service and it must be signed by the primary care doctor.   A completed RFC must have the diagnosis listed on the form.

PSR is likely unique from some of the other secondary programs you deal with, but our process is:

1. Case manager and/or interested person calls the program to set up tour, with myself checking to ensure they meet the admission criteria
2. After the tour, if the person’s interest is peaked, PSR sets up an orientation schedule to get a better, clearer idea and understanding of what services, supports, etc are available through the clubhouse
3. If following the orientation the person decides to become a member, I personally meet with them and officially open them to PSR; securing some initial paperwork (orientation check off list, ROI’s, etc) and assign them to a secondary case manager at PSR
4. The secondary case manager develops a treatment plan with the new member, with authorization attached.
5. Primary case manager reviews and signs tx plan, with authorization approved once signed.

This process does not exclude any additional correspondences or discussions with the primary case manager. Primary case managers should NOT open any potential members to PSR. In some cases individuals tour and/or do some of the orientation, but do not opt to become a member. Tours and orientation activities are not billed or authorized. Service billing begins once the individual becomes a confirmed member, open to the program with a PSR active plan.

In those circumstances where you need to record non-billable time spent with a client because you are working at the same time with another clinician who can bill for their time (e.g., Case Manager attending Dr appointment with client) you should select the Contact Type Consultant/Support instead of Face to Face on your SAL.  This will ensure that the service can be recorded for the accurate time period, but is not considered billable, so will not conflict the other staff’s billable code for the same time period.  The non-billable IND14 procedure code can be used, and you can select client or family present, etc. without error.

A message from GCCMH Consultative Services:

A physician order will no longer be accepted for a request for consultation for physical therapy, occupational therapy, registered dietician services, and speech-language therapy. You must submit these requests on the Request for Consultation form that is in CHIP. In addition, this form must be signed by the consumer’s primary care physician in order for the request to be in compliance with Medicaid standards. This is effective immediately. If you have any questions please feel free to contact Provider Relations.

There has been a new individual therapy code developed that will cover both 90804 20-30 minute sessions and 90806 45-50 minute sessions.  By selecting 9080X Individual therapy, you can bill for either a 90804 or a 90806, eliminating the need to request these two service codes separately.  The limit that will be auto-approved will be based on level of care and associated benefit plan.  The benefit plans are located on this web site in For Providers > Forms > Handouts and Administrative Forms, or for internal providers, the benefit plans can be located on the Intranet under “CHIP Information”.