MHP Provider Documents

This page is utilized by BHS Provider Staff to obtain forms, manuals and reports for the electronic health record, Cerner Community Behavioral Health.

SOC and NACT Tools and Resources

COVID-19

Coronavirus Disease 2019
COVID-19 FAQs for BHS Providers
How to Manage Your Mental Health and Cope During COVID-19
CA Health Alert Network (CAHAN)

NOABD

NOABD Webinar available online (new)


NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Modification_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Language_Assistance_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_ENGLISH.docx	-	2018-08-07
NOABD_Timely_Access_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Timely_Access_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Denial_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Modification_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Denial_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Termination_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Modification_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_ARABIC.docx	-	2018-08-07
NOABD_Modification_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Denial_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_VIETNAMESE.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_FARSI.pdf	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Language_Assistance_Notice_-_ENGLISH.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.pdf	-	2018-08-07
NOABD_Financial_Liability_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Termination_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Termination_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Termination_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Payment_Denial_Notice_-_VIETNAMESE.docx	-	2018-08-07
NOABD_Modification_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Modification_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Payment_Denial_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Financial_Liability_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.pdf	-	2018-08-07
NOABD_Timely_Access_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_TAGALOG.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_ARABIC.pdf	-	2018-08-07
NOABD_Denial_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Delivery_System_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_FARSI.docx	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Financial_Liability_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Your_Rights_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Denial_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Termination_Notice_-_FARSI.doc	-	2018-08-07
NOABD Log – FY 21-22 (xlsx)		2021-07-19
3.NOABD_Payment_Denial_Notice		2020-06-16
NOABD Denial Notice ENGLISH (doc)		2020-06-16
NOABD Log - FY 20-21 (xlsx)	Revised 01/26/2021	2021-01-27
NOABD Table (pdf)	Revised 01/08/2020	2020-01-08
NOABD Termination Notice - SPANISH (doc)		2020-05-08
SanWITS NOABD		2020-09-17
SanWITS NOABD		2020-09-17

Beneficiary


Beneficiary Materials MHP Order Form (docx)		2022-02-28
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 English (docx)	Revised 06/28/2018	2021-11-04
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Arabic (docx)		2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 7-1-18 Farsi (docx)		2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Vietnamese (docx)		2021-08-24
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Tagalog (docx)		2021-08-24
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Spanish (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Farsi (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Arabic (docx)		2021-08-24
Full Guide Spanish 2021 (pdf)	MHP – Beneficiary – Handbook – SPANISH_(REVISED 08.20.2021)	2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Spanish (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Vietnamese (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - English (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Tagalog (docx)		2021-08-23
Advance Directive Farsi (pdf)		2021-08-20
Advance Directive Spanish (pdf)		2021-08-20
Advance Directive Arabic (pdf)		2021-08-20
Advance Directive Tagalog (pdf)		2021-08-20
Advance Directive Vietnamese (pdf)		2021-08-20
Advance Directive English (pdf)		2021-08-20
Quick Guide To MH Services-Arabic (pdf)	Revised 06/29/2021	2021-08-20
Quick Guide To MH Services-English (pdf)	Revised 06/29/2021	2021-08-20
Quick Guide To MH Services-Farsi (pdf)	Revised 06/29/2021	2021-08-20
Quick Guide To MH Services-Spanish (pdf)	Revised 06/29/2021	2021-08-20
Quick Guide To MH Services-Tagalog (pdf)	Revised 06/29/2021	2021-08-20
Quick Guide To MH Services-Vietnamese (pdf)	Revised 06/29/2021	2021-08-20
NPP Acknowledgement Arabic (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement English (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Farsi (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Spanish (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Tagalog (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Vietnamese (pdf)	Revised August 2021	2021-08-20
CA Board of Psychology Consumer Statement-English (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Spanish (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Tagalog (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Vietnamese (pdf)		2021-07-27
MHP Beneficiary Handbook Cover in Threshold Languages (pdf)	Revised 07/10/2019	2021-07-19
San Diego Provider List Translation Instructions (pdf)		2021-07-19
SD Grievance-Appeal POSTER English LARGE FONT (pdf)	Revised 03/05/2019	2021-07-15
SD Grievance-Appeal POSTER Spanish (pdf)	Revised 03/06/2019	2021-07-15
SD Grievance-Appeal POSTER Arabic (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER English (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Farsi (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Tagalog (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Vietnamese (pdf)	Revised 03/06/2019	2021-07-14
Beneficiary Non-Discrimination Notice - ENGLISH (pdf)		2018-08-07
Full Guide Arabic 2019 (pdf)	Arabic	2019-07-10
Full Guide Farsi 2019 (pdf)	Farsi	2019-07-10
Full Guide Vietnamese 2019 (pdf)	MHP_Beneficiary_Handbook_Rv_5_01_2019_VIETNAMESE.pdf	2019-05-13
Full Guide Tagalog 2019 (pdf)	MHP_Beneficiary_Handbook_Rv_5_01_2019_TAGALOG.pdf	2019-05-13
Full Guide English 2019 (pdf)	MHP_Beneficiary_Handbook_1_24_2019.pdf	2019-02-01
Limited_English_Proficiency_Poster_Vietnamese_07-10-18.pdf	-	2019-02-07
Limited_English_Proficiency_Poster_Tagalog_07-10-18_.pdf	-	2019-02-07
Limited_English_Proficiency_Poster_Spanish_07-10-18.pdf	-	2019-02-07
Limited_English_Proficiency_Poster_Farsi_07-10-18.pdf	-	2019-02-07
Limited_English_Proficiency_Poster_English_07-10-18.pdf	-	2019-02-07
Limited_English_Proficiency_Poster_Arabic_07-10-18.pdf	-	2019-02-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_FARSI.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_SPANISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_TAGALOG.docx	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_FARSI.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_SPANISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_TAGALOG.docx	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_VIETNAMESE.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_TAGALOG.docx	-	2018-08-07
Notice_of_Grievance_Resolution_-_SPANISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_FARSI.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_ENGLISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_ARABIC.doc	-	2018-08-07
Beneficiary Non-Discrimination Notice - ENGLISH (doc)		2018-08-07
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.docx	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_SPANISH.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_FARSI.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_VIETNAMESE.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ENGLISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ENGLISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_VIETNAMESE.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_SPANISH.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_FARSI.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ARABIC.pdf	-	2018-08-07
Beneficiary_Non-Discrimination_Notice_-_VIETNAMESE.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_VIETNAMESE.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_TAGALOG.pdf		2018-08-06
13.Beneficiary_Non-Discrimination_Notice		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_SPANISH.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_SPANISH.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_FARSI.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_FARSI.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_ARABIC.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_ARABIC.doc		2018-08-06
Beneficiary Problem Resolution Process (doc)		2018-06-28
Grievance-Appeal Brochure Farsi (pdf)		2018-02-28
Advance_Directive_Farsi.pdf		2018-02-28
Notice of Privacy Practices - Farsi (pdf)		2018-02-13
Grievance-Appeal Brochure Arabic (pdf)		2017-11-27
Grievance-Appeal Brochure English (pdf)		2017-11-27
Grievance-Appeal Brochure Farsi (pdf)		2017-11-27
Grievance-Appeal Brochure Spanish (pdf)		2017-11-27
Grievance-Appeal Brochure Tagalog (pdf)		2017-11-27
Grievance-Appeal Brochure Vietnamese (pdf)		2017-11-27
055__-_OPOH_-_Appendix_D_-_A.D.20_-TBS_Brochure_English_2015.pdf		2017-03-23
NoticeofPrivacyPractices_Vietnamese_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Tagalog_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Spanish_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_English_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Arabic_12-16-14.pdf		2017-02-06
Physician_Notice_To_Patients_California_Regulation.pdf		2016-07-13
PUB 325 SP		2015-10-09
PUB325.pdf		2015-10-09

Communications


FAQ_-_Request_for_Servcies_Log_-_Access_Time_Report_-_9-30-14_.pdf		2016-07-15
QI_MIS_MEMO_2014_1_09_Notifications_in_Anasazi.pdf		2016-05-16
QM_Memo_-_90_Day_Lockout_Process_Update_11_06_13.pdf		2015-10-09
QM_MEMO_DHP_4_14.pdf		2015-10-09
QI_MIS_MEMO_2015_11_20_Saving_Reports_to_a_SpreadsheetProcess_and Policy.pdf		2015-11-30
QI_MIS_MEMO_2016_05_09_CCBH_Outside_of_the_Office_Update.pdf		2016-05-11
QI_MIS_MEMO_2016_10_31_CCBH_Demographic_Form_Table_Change.docx		2016-11-03
QI_MIS_MEMO_2016_12_01_CCBH_Client_Attachments.pdf		2018-05-25
QM_MEMO_- 42_CFR_Final_Rule_1-26-17.pdf		2017-02-02
QM_MEMO_-_Place_of_Service_Update_03_30_17.pdf		2017-03-31
QM_MEMO_-_Day_Treatment_Interim_Folder_03_29_17.pdf		2017-03-31
QM_MEMO_-_Allowed_Services_Prior_to_Client_Plan_Completion_-_DHCS_Guidelines_6_20_17.pdf		2017-06-21
QM_MEMO_-_New_Evidence_Based_Practice_Indicators_06_23_17.pdf		2017-06-27
QM_MEMO_-_Utilization_of_BHA_Adult_Walk_In_for_OP_Walk_In_Services_6_21_17.pdf		2017-06-27
QM_MEMO_-_Client_Plan_Redesign_6-20-17.pdf		2017-06-27
QM_MEMO_-_New_Auth_to_Use-Disclose_Multiple_Form_051513.pdf		2017-05-12
Intensive_Service_Request_ISR_CYF_Memo_04-1617.pdf		2017-06-30
QM MEMO_-_Specialty_Mental_Health_Service_Claiming_for_ES-HS_9_7_18.pdf		2018-10-08
2021-06-29-BHS Information Notice-CYF Utilization Management Reinstated Effective 7.1.21 (pdf)	Effective July 1, 2021	2021-06-30
2021-11-10-BHS Contractor Memo-Medi-Cal RX 2021 (pdf)		2021-11-15
3/19/20 BHS Provider Notice #3- COVID 1- Quality Improvement Updates and Best Practices (pdf)		2020-03-20
ASJ Memo 8-5-2020 (docx)		2020-08-05
ASJ Tip Sheet 8-5-2020 (docx)		2020-08-05
CSI Requirement for MH Programs 08 27 12 (pdf)		2016-07-15
CYF MEMO - Revised CANS Sharing Confirmation 3.26.19 (pdf)		2019-04-09
CYF MEMO - Updated Ancillary SMHS Request Form (pdf)	Effective 1/1/2020	2020-01-10
CYF MEMO - Utilization Management Outpatient Cycle Expansion (pdf)	Issued 12/20/2019	2019-12-30
CYF MEMO – IHBS Prior Authorization 08/16/19 (pdf)		2019-08-20
CYF MEMO – Revised UM Request Form (pdf)	Issued 09/03/2019	2019-09-06
CYF Memo Prior Auth for Day Services (pdf)	Effective 1-1-2020	2020-01-10
CYF Memo – TBS Prior Authorization Process (pdf)	Issued 7/29/19	2019-08-14
Medication Assisted Treatment (MAT) Referrals (pdf)		2020-08-27
Optum San Diego Website MH Provider Registration Instructions (pdf)		2019-11-04
PowerPoint Presentation		2020-01-21
QI - PIT MEMO - SOC Application (pdf)		2019-11-04
QI MIS MEMO CCBH Access to Services Journal (pdf)		2018-06-15
QI_PIT_MEMO_2018 6-1-18 AOA Substance Use Tracking Reporting Changes (pdf)		2018-06-14
QM MEMO - CSI Diagnosis errors (pdf)	Issued 12/26/2019	2019-12-30
QM MEMO - Controlled Substance - CURES Mandate (pdf)		2018-06-08
QM MEMO - Medication Monitoring (pdf)	Issued 01/31/2020	2020-01-31
QM MEMO - NOABD Logs (pdf)	Issued 01/31/2020	2020-01-31
QM MEMO - New BHS 025 Forms (docx)		2019-04-24
QM MEMO - New Updated Discharge Form - 4.4.19 (pdf)		2019-04-12
QM MEMO - Patient_Advocacy Services for BHS - Record Requests 11 01 18 (pdf)		2018-10-31
QM MEMO - Specialty Mental Health Service Claiming for ES-HS (pdf)		2018-09-10
QM MEMO – AOA Outpatient Utilization Management 06 29 18 (pdf)		2018-07-13
QM MEMO_-_New_Non-Bill_Other_Support_Service_Code_01_29_18.pdf		2018-11-29
QM Memo - CPT Coding Changes 2013 (pdf)		2016-07-15
QM Memo - Holder of Records 01 03 13 (pdf)		2016-07-15
QM Memo - New Billing Indicators - Intrepreter and Language 06-08-17 (pdf)		2017-06-14
QM Memo ICD-10 7-16-20 (pdf)		2020-07-17
QUALITY MANAGEMENT MEMO		2015-10-09
QUALITY MANAGEMENT MEMO		2015-10-09
QUALITY MANAGEMENT MEMO		2015-10-09
QUALITY MANAGEMENT MEMO		2015-10-09
QUALITY MANAGEMENT MEMO		2016-05-11
QUALITY MANAGEMENT MEMO		2018-07-13
QUALITY MANAGEMENT MEMO		2018-10-24
QUALITY MANAGEMENT MEMO		2019-01-09
QUALITY MANAGEMENT MEMO		2019-02-08
QUALITY MANAGEMENT MEMO		2019-02-08
QUALITY MANAGEMENT MEMO	Issued 12/06/2019	2019-12-09
QUALITY MANAGEMENT MEMO	Issued 02/06/2020	2020-02-07
System of Care (SOC) Application - (BHS) – Contractor Information Notice (pdf)	11/23/2020	2020-11-30

Forms


5150 Form (pdf)		2021-05-10
AOB - Arabic Version (docx)		2021-11-09
AOB - Arabic Version (pdf)		2021-11-05
AOB - English Version (docx)		2021-11-09
AOB - English Version (pdf)		2021-11-05
AOB - Spanish Version (docx)		2021-11-09
AOB - Spanish Version (pdf)		2021-11-05
AOB - Tagalog Version (docx)		2021-11-09
AOB - Tagalog Version (pdf)		2021-11-05
AOB - Vietnamese Version (docx)		2021-11-09
AOB - Vietnamese Version (pdf)		2021-11-05
BHS 025 Form A (docx)	Revised 4/2021	2021-11-09
BHS 025 Form B (docx)	Revised 4/2021	2021-11-09
BHS Serious Incident Report (docx)		2020-10-08
BHS Serious Incident Report Explanation (pdf)		2020-10-08
BHS Serious Incident Report Findings (docx)		2020-10-08
BHS Serious Incident Report of Findings Explanation (pdf)		2020-11-05
BHS-025 Form A and B Tip Sheet (docx)	Client Information - Revised 4/2019	2019-05-02
CCBH Void and Replace Form (xlsm)	Revised 10/04/2021	2021-10-07
Case Management Six Month Review Progress Note (pdf)		2017-03-23
Case Management UR Record (pdf)		2017-03-23
Case Management URC Minutes Form (pdf)		2017-03-23
DEMOGRAPHIC FORM FILL (docx)	Revised 06/01/2021	2021-05-28
DHCS 1739 Mental Health Professional Licensing Waiver Request (pdf)		2021-03-12
DPC 203 Contractor (xlsx)		2018-09-21
DPC 203 Fillable (pdf)		2021-02-19
DPC 203 IT Mobile Supplemental 2020 (pdf)		2021-02-19
DPC 203 Mobile Devices Form (pdf)		2021-02-19
DPC 203 Salvage and Disposal Flowcharts (pdf)		2019-06-03
Group Service Record (rtf)	Revised 08/2020	2020-08-07
HSD Medi-Cal Quick Guide Screening Tool (docx)		2021-12-13
Individual Service Record (doc)		2020-08-07
JV-220(A) Physician's Statement—Attachment	Judicial Council forms	2018-03-01
JV-220(B) Physician's Request to Continue Medication—Attachment	Judicial Council forms	2018-03-01
Job performance review guide		2020-08-07
MAA Service Record (pdf)		2017-08-24
Med Monitoring Submission Form – Adult (xlsx)	Revised 01/17/2020	2020-01-31
Med Monitoring Submission Form – Children’s (xlsx)	Revised 01/17/2020	2020-01-31
Med Monitoring Tool AOA (docx)	Revised 06/29/2021	2021-06-29
Med Monitoring Tool CYF (docx)	Revised 06/29/2021	2021-09-09
Med Monitoring Tool CYF (docx)		2021-09-17
Medi-Cal Administrative Activities (MAA) Procedures,MAA Procedures (pdf)		2017-08-24
Medication Disposal Log (pdf)		2021-06-03
Medication Monitoring Feedback Loop	Revised 01/17/2020	2020-01-31
Medication Monitoring Submission Form – Children (xlsx)		2018-07-26
Mental Health Professional Licensing Waiver Request (pdf)	DHCS 1739 Revised 11/2021	2022-01-10
NVRA Voter Preferences Form-Arabic (pdf)		2021-03-12
NVRA Voter Preferences Form-English (pdf)		2021-03-12
NVRA Voter Preferences Form-Spanish (pdf)		2021-03-12
NVRA Voter Preferences Form-Tagalog (pdf)		2021-03-12
NVRA Voter Preferences Form-Vietnamese (pdf)		2021-03-12
NVRA_Voter_Preference_Form_Farsi.pdf		2017-09-14
New MRR Hybrid Chart and Program Compliance CHECKLIST (docx)	Revised 02/12/2021	2021-02-18
New MRR Hybrid Chart and Program Compliance CHECKLIST (docx)		2020-10-05
Reestablishment Recommendation Form (doc)		2021-03-12
Request for Verification of Veterans Eligibility (pdf)		2017-03-23
SAN DIEGO COUNTY MENTAL HEALTH PLAN		2017-03-23
SERIOUS INCIDENT ROOT CAUSE ANALYSIS WORKSHEET (doc)	Revised 07/31/2012	2020-01-29
START TCC and URC Record (pdf)		2017-03-23
START URC Minutes Form (pdf)		2017-03-23
Service Authorization Request (pdf)		2021-03-12
Weekly Wait Times Report	FOR OFFICIAL USE ONLY	2018-06-20
Written Translation Service Authorization Form (pdf)		2021-03-12

Manuals


5150 Training Manual - May 2019 (pdf)		2021-03-23
Appendix III – Service Code Approved Use Summaries (pdf)	Revised 02/25/2019	2019-03-21
CAPS Inpatient Operations Handbook (pdf)	Revised 06/15/2021	2021-11-18
CYF BHS Provider Resources Manual (pdf)		2017-03-20
County Webinar ICD-10-CM Q and A Final 9-11-15 (docx)	Assessments	2016-07-08
Financial Eligibility and Billing Manual (pdf)		2018-09-24
Inpatient Operations Manual (pdf)		2020-07-30
MHP Beneficiary Handbook (pdf)		2019-02-12
Medi-Cal Manual - Third_Edition (pdf)		2018-01-19
Outcome Measures Manual San Diego CSS Programs (pdf)	Updated 06/19/2019	2019-06-28
Request for Services Access Times Log Manual (pdf)		2016-05-23

OPOH

References


EPSDT_TBS_Brochure_English.pdf		2016-07-15
EPSDT_TBS_Brochure_Spanish.pdf		2016-07-15
State_Plan_Amendment_SPA_12-025.pdf		2015-10-09
County_Webinar_ICD-10-CM_QandA_Final_9-11-15.docx		2016-07-15
ICD_10_and_DAS_Tip_Sheet_09.2015.docx		2016-07-15
036_-_OPOH_-_Appendix_D_-_A.D.02_-_Medical_Necessity_Criteria_for_MHP__-_Rev_7-14-09_.pdf		2017-03-23
037_-_OPOH_-_Appendix_D_-_A.D.03_-_California_State_Penal_Institutions_List_.pdf		2017-03-23
QI_UPDATES_-_Annual_7_11_17 FINAL.pdf		2017-07-13
State_Health_Information_Guidance_-_December_2017.pdf		2017-12-18
Program_Provider_Numbers_List.pdf		2018-02-15
Travel_Time_Guidelines_Final_2-01-18.pdf		2018-02-15
FAQs from CPT Changes 2013 Webinar (pdf)		2016-07-15
Setting the Face Sheet to Display Instructions (doc)		2016-07-15
CCBH_-_CP_Folder_and_PN_TIP_SHEET-updated_6_16_17.pdf		2017-06-27
CCBH_-_Quick_Click_Guide_REVIEW_-_REVISE-updated_6_16_17.pdf		2017-06-27
CCBH_CP_Quick_Click_Guide-updated_6_16_17.pdf		2017-06-27
Client_Management_Payment_Report_V3.pdf		2016-07-15
CPT_Changes_2013_Presentation.pdf		2015-10-09
CPT_Codes_New_2013.pdf		2015-10-09
CPT_2013_Coding_Changes_FAQ.doc		2016-07-15
PWB Report Template Instructions (pdf)		2016-05-16
Payment Appilication Claims Report Instructions (pdf)		2016-05-16
Service_Date_Verification_Report.pdf		2016-05-16
BHS Quality Improvement 8th Annual Mental Health Providers Knowledge Forum - Presentation handout.pdf		2021-09-07
BHS Quality Improvement 8th Annual Mental Health Providers Knowledge Forum - Question-Answer Sheet.pdf		2021-09-07
3rd Party Suspense Report		2019-04-10
7th Annual Mental Health Forum 9.22.20 - QA (docx)		2020-10-08
Abbreviation and Definitions List - BHS (doc)	Revised 11/30/2016	2016-11-30
Active Parolee Clients Report Instructions (docx)		2020-10-01
BHS Information Notice-Utilizing CANS Strengths in Therapy	03/09/2021	2021-03-10
BILLING LOCKOUT SETTINGS AND NON-REIMBURSABLE / REIMBURSABLE ACTIVITIES (pdf)		2018-08-10
CCBH Report Uses for Program Integrity (pdf)		2019-10-07
CSI Correction Guide – Full Version (pdf)		2021-01-29
CSI Correction Guide – Most Frequent Errors (pdf)		2021-01-29
CYF Brief Treatment Model (docx)		2020-10-30
Case Management versus Collateral (docx)		2021-03-15
Client Categories Maintenance (pdf)		2018-06-29
Client Categories – Parolee Tip Sheet (docx)		2020-07-31
Clinical Standard for Assessments (doc)		2018-06-15
Clinical Standards For Client Plans (pdf)	Updated 6/28/2019	2019-07-01
Crisis Intervention SC 70 Guideline (pdf)		2020-09-09
DHCS and COSD Billing Guidelines (docx)		2021-02-02
Denial Report		2019-09-16
Diagnosis Practice Guidelines (pdf)	Updated 01/24/2022	2022-01-25
EM 102 CPT Coding Changes - 2013 (pdf)		2015-10-09
HOW Service Model Data Collection Flow (pdf)		2021-03-12
List of Controlled Substance 08.20.20 (pdf)		2020-09-01
MAA Procedures (pdf)		2021-03-12
MAA Service Record (pdf)		2021-03-12
MIS-25 Program Listing Report (xlsx)	Updated 02/2022	2022-02-14
MRR TOOL FY 20-21 (xlsx)	Revised 08/17/2020	2020-12-09
MRR Tool FY 21-22 (xlsx)	Revised 07/07/2021	2021-07-30
Medi-Cal Certification Recertification Tool (xls)		2020-05-05
Medi-Cal Rx Provider Registration and Training FAQs (pdf)		2021-12-16
Medi-Cal Rx Provider Training Checklist (pdf)	Revised 11/04/2021	2021-12-16
Medi-Cal Rx UAC Registration Quick Start Guide (pdf)		2021-12-16
Medical Necessity CalAIM Updates (docx)	Active 01/01/2022	2021-12-15
Medication Monitoring Process Flow Chart for Org Providers (pdf)		2021-04-27
Medication Services FAQ (docx)		2021-04-14
Mental Health Professional Licensure Waiver (pdf)		2021-01-06
Microsoft PowerPoint - Presentation EM 101 for 12-3-2012 FINAL		2015-10-09
New Contractor Orientation Resources (docx)	Revised 06/22/2020	2020-06-23
PowerPoint Presentation	07-25-2018 Presentation	2018-07-26
PowerPoint Presentation	presented July 12, 2019	2019-07-18
Progress Note Checklist Table (pdf)	Checklist	2020-03-10
QI UPDATES MHP 7th ANNUAL 09.22.20 (pdf)		2020-10-08
RCA WORKSHEET Sample (pdf)		2021-03-12
Reasons for Recoupment Changes Grid (docx)	Active 01/01/2022	2021-12-15
Reasons for Recoupment FY 2018-19 (pdf)		2019-01-22
SOC Application - QIP Presentation (pdf)	Presented 10/22/19	2019-10-23
Service Code Definitions Appendix III (pdf)	Revised 12/10/2021	2021-12-13
Short-Doyle Medi-Cal (SDMC) Aid Code Master Chart (pdf)	Updated Aid Code Master Chart	2021-01-28
Telehealth Reminder Slides_QIP-July 2020 (pdf)	PowerPoint Presentation 10/22/2018	2020-07-29
Tip Sheet For Billable Services (docx)		2019-06-26
Transferring Clients Between Different Program Sites (docx)		2020-08-25
Trauma-Informed Care Code of Conduct (pdf)		2019-06-17
Treatment Team Documentation Standards (pdf)		2018-09-11
Utilizing CANS Strengths in Therapy (pdf)	March 2021	2021-03-10
Who to Contact List (pdf)		2021-04-20

UCRM


BHA TBS Form Fill (doc)	Revised 02/02/2022	2022-02-07
BHA - ADULT PAPER FORM INSTRUCTIONS (docx)	Revised 02/02/20222	2022-02-04
BHA - CHILDREN PAPER FORM INSTRUCTIONS (docx)	Revised 02/02/20222	2022-02-04
BHA - ESU EXPLANATION (docx)	Revised 02/02/20222	2022-02-04
BHA - EXPLANATION (docx)	Revised 02/02/20222	2022-02-04
BHA - TBS EXPLANATION (docx)	Revised 02/02/20222	2022-02-04
BHA - ADULT WALK IN FORM FILL (doc)	Revised 01/31/2022	2022-02-04
BHA - 0-5 FORM FILL (docx)	Revised 01/31/2022	2022-02-04
BHA – ADULT FORM FILL (doc)	Revised 01/31/2022	2022-02-04
BHA - CHILDREN FORM FILL (docx)	Revised 01/31/2022	2022-02-04
BHA - CRISIS STABILIZATION UNIT FORM FILL (doc)	Revised 01/31/2022	2022-02-04
BHA - DEC FORM FILL (doc)	Revised 01/31/2022	2022-02-04
BHA - ESU FORM FILL (doc)	Revised 01/31/2022	2022-02-04
BHA - START FORM FILL (doc)	Revised 01/31/2022	2022-02-04
BHA -CHILDREN JFS STAT FORM FILL (doc)	Revised 01/31/2022	2022-02-04
DEMOGRAPHIC FORM FILL (docx)	Revised 01/21/2022	2022-01-28
MCRT ASSESSMENT (docx)	Revised 11/02/2021	2022-01-25
SD-CANS Explanation (docx)	Revised 05/14/2021	2021-10-26
UM Request Form (docx)	Revised 10/15/2021	2021-10-14
UM Request Explanation Sheet (docx)	Revised 10/15/2021	2021-10-14
YOUTH TRANSITION SELF EVALUATION EXPLANATION (docx)		2021-08-20
PSC-35 Explanation (docx)	Revised 08/20/2021	2021-08-20
CRISIS STABILIZATION UNIT REASSESSMENT PROGRESS NOTE (docx)	Revised 06/11/2021	2021-06-24
CRISIS STABILIZATION UNIT DAILY DOCUMENTATION PROGRESS NOTE (docx)	Revised 06/11/2021	2021-06-24
CRISIS STABILIZATION UNIT DISCHARGE PROGRESS NOTE (docx)	Revised 06/11/2021	2021-06-24
PROSPECTIVE RISK ANALYSIS (PRA) (docx)	Revised 05/2021	2021-05-28
CANS EXPLANATION (docx)	Revised 05/25/2021	2021-05-25
TBS PROGRESS NOTE FORM_FILL (docx)		2020-08-07
CLIENT PLAN - CHILDREN EXPLANATION (docx)	Revised 05/2021	2021-05-20
DEMOGRAPHIC FORM EXPLANATION (docx)	Revised 05/2021	2021-05-20
DISCHARGE SUMMARY EXPLANATION (docx)	Revised 05/2021	2021-05-20
HIGH RISK ASSESSMENT EXPLANATION (docx)	Revised 05/2021	2021-05-20
INFORMED CONSENT PSYCHOTROPIC MEDS EXPLANATION (docx)	Revised 05/2021	2021-05-20
PROSPECTIVE RISK ANALYSIS PRA EXPLANATION (docx)	Revised 05/2021	2021-05-20
Children’s Uniform Chart Order (docx)	Revised 05/11/2021	2021-05-12
Adult Clinical Record Chart Order (docx)	Revised 05/11/2021	2021-05-12
PROGRESS NOTES EXPLANATION (docx)		2021-04-08
RMQ QUESTIONNAIRE FORM (pdf)		2021-02-02
IMR CLINICIAN ASSESSMENT FORM (pdf)		2021-02-02
RMQ QUESTIONNAIRE FORM (pdf)		2021-01-22
CASE MANAGEMENT PROGRESS NOTE FORM FILL (docx)	Revised 12/08/2020	2020-12-09
CLIENT PLAN FORM FILL (docx)	Revised 10/27/2020	2020-11-03
TFC Prior Authorization Request Final (docx)		2020-10-15
TFC Prior Authorization Request Explanation (docx)		2020-10-15
TFC DAILY PROGRESS NOTE FORMFILL (doc)		2020-10-06
NURSING NOTE FORM FILL (docx)		2020-09-17
COLLATERAL PROGRESS NOTE FORM FILL (doc)		2020-08-10
WRAPAROUND PROGRESS NOTE FORM FILL (doc)		2020-08-10
Medication Progress Note SC28 (docx)		2020-08-07
WALK IN ASSESSMENT PROGRESS NOTE FORM FILL (doc)		2020-08-07
INDIVIDUAL PSYCHOTHERAPY PROGRESS NOTE FORM FILL (doc)		2020-08-07
Recovery Markers Questionnaire Form 093009 (pdf)		2020-07-14
PROSPECTIVE RISK ANALYSIS (PRA) FORM FILL (docx)		2020-07-02
Youth Transition Self Evaluation Formfill (docx)		2020-06-18
INITIAL SCREENING PERT FORM FILL (docx)	Revised 04/01/2020	2020-04-15
10 2018 PSC - Parent interactive (pdf)	Revised 3/2020	2020-03-26
10 2018 PSC - Youth Interactive (pdf)	Revised 3/2020	2020-03-26
Service Indicator Table Key (docx)		2020-03-18
NEVER BILLABLE PROGRESS NOTE FORM FILL (doc)		2020-03-18
OTHER PROGRESS NOTE FORM FILL (doc)		2020-08-07
DAY TREATMENT WEEKLY SUMMARY INSTRUCTIONS (docx)		2020-01-22
DAY TREATMENT WEEKLY SUMMARY (doc)		2020-01-22
PRIOR AUTHORIZATION DAY SERVICES REQUEST - EXPLANATION (pdf)		2020-01-10
ANCILLARY SMHS REQUEST - EXPLANATION (pdf)		2020-01-10
ANCILLARY SMHS REQUEST - FORM FILL (docx)		2020-01-10
PRIOR AUTHORIZATION DAY SERVICES REQUEST - FORM FILL (docx)		2020-01-10
PSYCHIATRIC ASSESSMENT EHR EXPLANATION (docx)		2019-12-12
TBS PRIOR AUTHORIZATION REQUEST AND REFERRAL FORM FILL (docx)		2019-08-14
TBS PRIOR AUTHORIZATION REQUEST AND REFERRAL – EXPLANATION (pdf)		2019-08-14
IHBS PRIOR AUTHORIZATION REQUEST FORM FILL (docx)		2019-08-20
IHBS PRIOR AUTHORIZATION REQUEST – EXPLANATION (pdf)		2019-08-20
Medication Progress Note SC27 (docx)		2020-08-07
Medication Progress Note SC26 (docx)		2020-08-07
Medication Progress Note SC25 (docx)		2020-08-07
Medication Progress Note SC24 (docx)		2020-08-07
DISCHARGE SUMMARY PAPER FORM INSTRUCTIONS (doc)	Uploaded 07-05-2019	2019-07-05
MEDICATION PROGRESS NOTE SC28 (docx)	Uploaded 07-05-2019	2019-07-05
CLIENT PLAN SIGNATURE PAGE (docx)		2019-07-03
LOCUS Instrument Version 20 (pdf)	Adult Version 20, December 2016	2019-06-28
DISCHARGE SUMMARY FORM FILL (docm)		2019-04-15
CANS SHARING CONFIRMATION FORM FILL (docx)		2019-04-15
CANS Sharing Confirmation page - Client Plan (pdf)		2019-04-09
CANS Sharing Confirmation - Explanation Sheet (pdf)		2019-04-09
CANS Family Letter (pdf)		2019-03-29
AOA OUTPATIENT UM EXPLANATION FORM 1.31.19.docx	Revised 01/31/2019	2019-02-08
AOA OUTPATIENT UM FORM FILL (docx)		2019-02-08
HIGH RISK ASSESSMENT EXPLANATION (docx)		2019-02-08
CLIENT ASSIGNMENT FORM (doc)		2018-08-14
AOA PATIENT MEDICATION AGREEMENT – EXPLANATION (docx)		2018-07-26
INFORMED CONSENT PSYCHOTROPIC MEDICATION ENGLISH (docx)		2021-03-05
INFORMED CONSENT PSYCHOTROPIC MEDS EXPLANATION (docx)		2018-07-26
WRAPAROUND PROGRESS NOTE FORM FILL (doc)		2018-07-24
MEDS MANAGEMENT LONG NOTE FORM FILL (doc)		2020-08-07
INDIVIDUAL REHAB PROGRESS NOTE FORM FILL (doc)		2020-08-07
GROUP REHAB PROGRESS NOTE FORM FILL (doc)		2020-08-07
GROUP PSYCHOTHERAPY PROGRESS NOTE FORM FILL (doc)		2020-08-07
FAMILY REHAB PROGRESS NOTE FORM FILL (doc)		2020-08-10
FAMILY PSYCHOTHERAPY PROGRESS NOTE FORM FILL (doc)		2020-08-10
ESU NURSING NOTE FORM FILL (docx)		2020-08-17
AOA Patient Medication Agreement English (pdf)		2018-06-08
CLIENT PLAN - ADULT EXPLANATION (docx)		2018-02-13
PSYCHIATRIC ASSESSMENT FORM FILL (doc)		2018-02-13
AIMS FORM FILL (doc)		2018-02-13
WEEKLY SUMMARY EXPLANATION (docx)		2018-02-13
TBS TREATMENT PLAN EXPLANATION (docx)		2018-02-13
SATS-R ADULT OUTCOME EXPLANATION (docx)		2018-02-13
MORS ADULT OUTCOME EXPLANATION (docx)		2018-02-13
LOCUS ADULT OUTCOMES EXPLANATION (docx)		2018-02-13
IMR ADULT OUTCOMES EXPLANATION (docx)		2018-02-13
SAFETY ALERTS FORM FILL (doc)		2018-02-13
INITIAL SCREENING FORM FILL (doc)		2018-02-13
DIAGNOSIS FORM (docx)		2018-02-13
DIAGNOSIS FORM EXPLANATION (docx)	Revised 05/26/2021	2021-05-26
AUTHORIZATION TO USE OR DISCLOSE PHI EXPLANATION (docx)		2018-02-09
TIERS EMOTIONAL BEHAVIORAL PSYCHIATRIC (docx)		2018-02-09
INITIAL SCREENING PERT PAPER FORM INSTRUCTIONS (doc)		2017-11-28
Explanation for Eligibility Form (pdf)		2017-10-25
TIERS TRAUMA (docx)		2018-05-25
TIERS TABLE EXPLANATION (docx)		2018-05-25
TIERS STRESS (docx)		2018-05-25
TIERS SPIRITUAL (docx)		2018-05-25
TIERS SOCIAL FUNCTIONING (docx)		2018-05-25
TIERS POTENTIAL FOR HARM (docx)		2018-05-25
TIERS PHYSICAL HEALTH PROBLEMS (docx)		2018-05-25
TIERS NEUROLOGICAL BRAIN IMPAIRMENT (docx)		2018-05-25
TIERS NEGLECT ABUSE (docx)		2018-05-25
TIERS MEANINGFUL ROLE (docx)		2018-05-25
TIERS LEGAL (docx)		2018-05-25
TIERS LACK OF PHYSICAL HEALTH CARE (docx)		2018-05-25
TIERS INTIMATE RELATIONSHIPS (docx)		2018-05-25
TIERS IDENTITY ISSUES (docx)		2018-05-25
TIERS FINANCIAL (docx)		2018-05-25
TIERS FAMILY STRESS (docx)		2018-05-25
TIERS EDUCATION (docx)		2018-05-25
TIERS BASIC NEEDS (docx)		2018-05-25
TIERS ABUSE ADDICTION (docx)		2018-05-25
TBS CLIENT PLAN SIGNATURE PAGE (docx)		2018-05-25
TBS CLIENT PLAN FORM FILL (docx)		2018-05-25
STRENGTHS TABLE (docx)		2018-05-25
SATS-R FORM 2 (doc)		2017-03-02
SAFETY ALERTS EXPLANATION (docx)		2018-05-25
SAFETY ALERT PAPER FORM INSTRUCTIONS (doc)		2017-03-02
TRANSITIONAL YOUTH REFERRAL PLAN FORM FILL (doc)		2018-05-25
TRANSITIONAL YOUTH REFERRAL PLAN EXPLANATION (docx)		2018-05-25
TRANSITIONAL AGE YOUTH REFERRAL P&P (doc)		2017-03-02
TIERS VOCATIONAL EMPLOYMENT (docx)		2018-05-25
VITALS FORM FILL (doc)		2017-03-02
REQUEST FOR ACCESS COPY OF PHI (doc)		2017-02-17
RELEASE OF INFORMATION CHILD 04-24A-P (dot)		2017-02-17
PSYCHIATRIC ASSESSMENT PAPER FORM INSTRUCTIONS (doc)		2017-02-17
MY SAFETY PLAN FORM FILL ENGLISH (docx)		2018-01-19
MY SAFETY PLAN EXPLANATION (docx)		2018-06-21
MORS ADULT OUTCOME MEASURE (docx)		2018-05-25
MEDICAL CONDITION REVIEW FORM EHR (docx)		2018-05-25
MEDICAL CONDITION REVIEW EXPLANATION (docx)		2018-05-25
HIGH RISK INDEX FORM FILL (docx)		2018-05-25
HIGH RISK ASSESSMENT FORM FILL (docx)		2018-05-25
ECBI EXPLANATION (docx)		2018-05-25
INITIAL SCREENING PAPER FORM INSTRUCTIONS (doc)		2017-02-17
DAY TREATMENT CLIENT PLAN (doc)		2017-02-17
COORDINATION OF CARE FORM EXPLANATION (docx)		2018-05-25
COORDINATION OF CARE FORM (docx)		2018-05-25
CONSENT FOR SERVICES EXPLANATION (docx)		2018-05-25
CONSENT FOR SERVICES (docx)		2018-05-25
CLIENT INFORMATION FACE SHEET EXPLANATION (docx)		2018-05-25
Authorization to Use or Disclose PHI - ENGLISH (pdf)	English	2017-02-17
Authorization to Use or Disclose PHI - CHILD (dot)		2017-02-17
ADVANCE DIRECTIVE ADVISEMENT EXPLANATION (docx)		2018-05-25
ADVANCE DIRECTIVE ADVISEMENT (doc)		2018-05-25
ACKNOWLEDGEMENT NPP (docx)		2018-05-25

UTTM

Training

Progress Notes Orientation and Practice Exercises available online (new)
Client Plans and Progress Notes Orientation and Practice Exercises available online (new)
CCBH Login Process Tutorial available online (new)
Progress Notes and Service Codes Webinar available online (new)
NOABD Webinar available online
Service Indicators Webinar available online
BHA Webinar available online
Client Plan Webinar available online
Progress Notes v3 Video Tutorials available online
Billing Correction Tutorials available online
Access to Services Journal Video Tutorial available online.

Progress Note Correction Resources

Claim It Anyway PowerPoint Presentation (ppt)

Other Training Resources and Tip Sheets

PWB


Explanation_for_Eligibility_form-10-25-17.pdf		2017-11-07
Eligibility-for-PWB-and-Enhanced-Services-Form-Fill-09.20.2017.docx		2017-11-07
Child and Family Team (CFT) Meeting Note Explanation (pdf)	Revised 01/14/2021	2021-02-11
Child and Family Team CFT Meeting Note Form Fill 11.30.2021 (docx)		2021-12-02
Intensive Care Coordination (ICC) (pdf)		2018-06-21
Intensive Care Coordination (ICC) Note Explanation (pdf)		2018-10-30
Progress Report to Child Welfare Services Explanation (10-4-18) (pdf)		2018-10-05
Progress Report to Child Welfare Services Form Fill (10-4-18) (docx)		2018-10-05

BHS Reports


AOA Annual Medication Monitoring Report FY 16-17 (pdf)		2017-11-30
AOA Annual Medication Monitoring Report Q2 FY17-18 (pdf)		2018-02-12
BHS Dashboard October 2017 (pdf)		2017-11-07
BHSDatabook_FY16-17_Final.pdf		2018-02-09
BHSDatabook_FY2014-15.pdf		2016-05-25
CYF Annual Medication Monitoring Report FY 16-17 (pdf)		2017-11-30
CYF Medication Monitoring Report Q2 FY17-18 (pdf)		2018-02-12
FY_2016-17_BHS_Factsheet_Combined_FINAL.pdf		2018-02-09
Medical Record Reviews FY 2017-18 Trending Questions Summary AOA and CYF Programs Q3 FY 2017-18 (pdf)		2018-05-01
Mental Health Performance Dashboard Combined - FY2017-18 (pdf)		2018-01-22
QM - MRR - Trending Questions Report - Q1 FY 18-19 (pdf)		2018-10-05
QM - MRR - Trending Questions Report - Q1 FY 19-20 (pdf)		2019-10-25
QM - MRR - Trending Questions Report - Q2 FY 18-19 (pdf)		2019-01-24
QM - MRR - Trending Questions Report - Q3 FY 18-19 (pdf)		2019-05-01
QM – MRR – Trending Questions – Q1 FY 20-21 (pdf)		2020-10-28

STRTP


AB1299 STRTP Admission Report (docx)	Revised 03/02/2021	2021-03-02
AB1299 STRTP Admission Report Explanation Form (pdf)	Revised 03/02/2021	2021-03-02
BHS Contractor Memo-Revised AB1299 STRTP Admission Report (pdf)	Memo Date : 03/02/20121	2021-03-02
BHS Contractor Memo-Revised STRTP Forms - Effective November 2020 (pdf)	Memo - 11/20/2020	2020-11-25
CYF MEMO – STRTP Release of Forms 08/16/19 (pdf)		2019-08-20
Day Treatment Weekly Progress Note (pdf)		2021-10-01
Optional AB1299 STRTP Tracking Tool (xlsx)	Revised 03/02/2021	2021-03-02
STRTIP UTILIZATION MANAGEMENT REQUEST – EXPLANATION (pdf)	Revised 11/20/2020	2020-11-25
STRTP ADMISSION STATEMENT FORM FILL (docx)		2020-11-25
STRTP ADMISSION STATEMENT – EXPLANATION (pdf)	Revised 06/24/2019	2020-11-25
STRTP DISCHARGE SUMMARY FORM FILL (docm)		2020-11-25
STRTP DISCHARGE SUMMARY – EXPLANATION (pdf)	Revised 07/12/2019	2020-11-25
STRTP Hybrid Matrix (docx)	Revised 12/10/2020	2020-12-11
STRTP MEDICATION NOT PRESCRIBED PROGRESS NOTE SC11 (docx)		2020-11-25
STRTP Medication Flow Chart (pdf)	Uploaded 07-05-2019	2019-07-05
STRTP PRIOR AUTHORIZATION DAY SERVICES REQUEST (DSR) (docx)	Revised 11/20/2020	2020-11-25
STRTP PRIOR DAY AUTHORIZATION DAY SERVICES REQUEST - EXPLANATION (pdf)	Revised 11/20/2020	2020-11-25
STRTP TRANSITION DETERMINATION PLAN FORMFILL (docx)	Revised 09/02/2021	2021-09-07
STRTP Transition Determination Plan Explanation Form (docx)	Revised 09/02/2021	2021-09-07
STRTP UTILIZATION MANAGEMENT REQUEST FORM FILL (docx)	Revised 11/20/2020	2020-11-25
Transition Determination Plan Signature Page (docx)	Revised 09/02/2021	2021-09-07