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Q. How can I get an updated Individual and Group
Provider Operations Handbook?
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| A. The provider handbook is available in PDF format on the Provider Website.
If you would like a hard copy and you are unable to print the handbook from the website please call the UBH
Provider Line, 1-800-798-2254, choose option 4, and request an
Individual and Group Provider Operations Handbook. [Back
to FAQs]
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Q. What should I do if my address or telephone number changes?
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| A. For all changes to provider addresses, telephone numbers, and tax
identification numbers please send in a written notification to UBH Provider Services at:
United Behavioral Health
P.O. Box 601370
San Diego, CA 92160-1370
or send by fax to (619) 641-6979. The form for filing changes, called the Provider Update Form (PUF),
is available in the back of the provider handbook or in the Forms section of the website.
[Back to FAQs]
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Q. What should I do if my availability for referrals changes?
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| A. For all changes to your availability for referrals please send
in a written notification to UBH Provider Services to the addressor fax number listed above. The
Provider Update Form (PUF) may be used to update referral status, and is available in the back of
the provider handbook or the Forms section of the website. [Back
to FAQs]
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Q. Do I need to receive preauthorization from UBH to see Medi-Cal clients?
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| A. Yes. Services must be preauthorized except in clinical emergencies.
Pre-authorization can be obtained by calling the Access and Crisis Line at 1-800-479-3339.
[Back to FAQs]
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Q. Should I always receive a UBH authorization letter to see a Medi-Cal client?
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| A. Yes. Authorization letters are mailed out by UBH within ten days. If
you have not received an authorization letter in this timeframe, you may call the Provider Line at
1-800-798-2254 and choose option 2 to speak to a care manager. [Back
to FAQs]
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Q. How often do I need to request additional authorizations for services to Medi-Cal
clients after the preauthorized sessions have been used or expire?
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A. The San Diego Mental Health Plan requires that services for children
and adults must be authorized every ninety (90) days for continued treatment.
- For children (<18) you must fax the Outpatient Assessment/Progress Report to
(619) 641-6802 for UBH care managers to review.
- For adults (18 +), call the Provider Line at 1-800-798-2254, chose option 3.
[Back to FAQs]
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Q. How can I get authorization if my adult client is in crisis and needs to be seen
more then six times in a three-month period?
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| A. If your adult client is in crisis and needs to be seen more often in order
to be stabilized and to reduce the possibility of hospitalization, please utilize the following procedure:
Call 1-800-798-2254, chose option 2, to obtain an authorization for one visit and then fax an Outpatient
Assessment/ Progress Report to (619) 641-6802 for review by UBH care managers.
Include:
- the nature of
the crisis situation,
- how additional sessions will help to stabilize the client, and
- for how long will
period additional sessions be needed in order to stabilize the client. A UBH care manager will review your
request for additional sessions and call you back to authorize or discuss your request. If your request is
denied, you may appeal the decision. [Back to
FAQs]
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Q. Can providers request technical assistance?
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| A. Yes. You may call the Provider Line, 1-800-798-2254, and chose
option 4. [Back to FAQs]
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Q. How can I obtain Language Interpreting Services for my practice?
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| A. UBH authorizes initial and ongoing
verbal and sign language interpreting services
for Medi-Cal clients, to be used during the provision of authorized Specialty Mental Health Services (e.g. psychotherapy
visit). It is important that you communicate clearly your need to
obtain interpreting services to the UBH clinician to ensure
availability when you need them. Upon receiving verbal
authorization for interpreting services, it will be necessary for you to contact the
approved vendor directly to schedule an appointment time. UBH
will mail or fax the language interpretation authorization form to your office and to
the vendor to document authorization for interpreter services.
Contact Interpreters Unlimited, at 1-800-726-9891,
for verbal language needs.
Contact Network Interpreting
Services, at 1-800-284-1043, for sign language needs.
Please be advised that the public
funding resources for language interpreting services are limited – if you need to cancel a requested
language service, please do so at least 24 hours prior to the appointment.
[Back to
FAQs]
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Q. Why does the provider contract application ask me to disclose my cultural
(ethnic) identity, sexual orientation, and religious affiliation?
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| A. Responses to these items are optional. Some providers have expressed
concern that their responses might entirely restrict the type of referrals they receive or might somehow
be used to discriminate against them. Neither of these is true. Providers are encouraged to answer
because this information is used to facilitate the most appropriate referral, taking into account client
preferences.
Title 9 requires that the client and provider "match" take into consideration the linguistic,
ethnic, age, and gender preferences of the client. Additionally, the San Diego Mental Health Plan considers
sexual orientation and spirituality or religious background to be important cultural variables. Therefore,
these have been included on the contract application. [Back
to FAQs]
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Q. What happens if I evaluate someone referred to me by the MHP, and I determine that
they do not meet Title 9 medical necessity criteria for Specialty Mental Health Services?
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| A. On occasion, you may conduct an assessment for a person referred by
the MHP who, in your judgment, does not meet medical necessity criteria for Specialty Mental Health
Services. Should this occur, you are required by Title 9 to give that person a NOTICE OF ACTION-A
(NOA-A) form. A copy of the NOA-A form is available in the forms section of the Individual and Group
Provider Operations Handbook or the website. [Back
to FAQs]
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Q. What happens if I determine that it is time to reduce or discontinue the level
of services I am providing to a Medi-Cal client?
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| A. In the above situation, you are required by Title 9 to give that client
a NOTICE OF ACTION-B (NOA-B). A copy of the NOA-B form is available in the forms section of the Individual
and Group Provider Operations Handbook or the website. [Back
to FAQs]
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Q. What is a Notice of Action (NOA)?
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| A. Both the NOA-A and NOA-B describe the client's right to a second opinion,
the right to treatment by a provider outside of the MHP, the right to file a complaint or grievance, and the
right to request a State Fair Hearing at any time. If the client chooses to exercise any of these rights,
he or she must contact the appropriate office, as indicated on the front and back of the NOA-A and the
NOA-B form.
You must check the reason medical necessity criteria were not met on the NOA forms prior to giving a copy
to the client. It also is important that you contact UBH Utilization Management at 1-800-789-2254, chose
option 3, to advise UBH that the client has been assessed as not meeting medical necessity criteria and has
been provided with an NOA-A or an NOA-B. [Back
to FAQs]
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Q. What is a Second Opinion?
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| A. If a client does not agree with the decision to deny or reduce
treatment, he or she has the right to obtain a Second Opinion. The client or the provider may ask the
MHP to arrange for the second opinion. To do this, it is necessary to call and talk to a representative
of the MHP plan at 1-800-479-3339 or write to:
Utilization Management
United Behavioral Health
P.O. Box 601370
San Diego, CA 92160-1370 [Back to FAQs]
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Q. How do I handle client complaints and grievances?
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| A. In accordance with Title 9, it is a provider's responsibility to inform
clients of their right to file a complaint or grievance at any time to express dissatisfaction with MHP
services. The client's right to express concerns is described in the MHP’s Complaint and Grievance
brochure.
Resolution procedures to address client concerns also are described in the brochures. Title
9 requires that all providers ensure that these brochures are available to clients and families in
English, Spanish, and Vietnamese, without the need of a verbal or written request by the client.
Additional copies of the Complaint and Grievance brochure may be obtained by contacting the San Diego
County MHP Quality Management department at: (619) 692-8058.
Providers are also required by Title 9 to maintain a log in which all client concerns or complaints are
entered. The client’s concern may be expressed to you verbally or in writing.
[Back to
FAQs]
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