Primary Quality Improvement Responsibilities of PBH
Providers
Published: October, 2001
Adhere to timeliness standards for appointments:
For routine, non-urgent cases, offer initial appointment
within five business days. All members referred on a
routine basis must be seen within 10 business days of
the date of referral.
For urgent cases, schedule appointment to occur within
48 hours
For emergent care, schedule appointment to occur
immediately
PBH is continually monitoring the ease with which its
members can gain access to appointments and services. This
monitoring occurs both internally as it relates to PBH's
own performance, as well as practitioner and provider performance.
Note
Providers will be specifically informed by PBH staff
if a case is urgent or emergent
Call PBH whenever a member fails to keep an urgent or
emergent appointment.
Respond to requests for information from any PBH committee
within the time period stated in the document requesting
the information.
Adhere to standards for documentation of member records
and for submission of routine clinical information to PBH
(PAR form, Y/LSQ).
Respond in a timely manner to requests from PBH for non-routine
member information (e.g., information required for special
studies).
Notify PBH within 30 days of any accusation or action
(suspension, probation or loss) against license to practice
independently in any state.
If treating a member who is also receiving services from
another behavioral health provider, communicate with that
provider regarding treatment planning.
Complete Health Care Coordination Form for every member
seen and mail or fax to Primary Care Physician to ensure
that behavioral health care and primary care services are
coordinated.
Adhere to state and federal laws regarding reporting
of suspected abuse and "duty to warn."
Notify Care manager immediately of member death or suicide
attempt resulting in a need for medical attention.
For PBH members, adhere to principles of short-term,
focused, goal-oriented treatment.
Refer member to community-based support services early
in treatment.
Always obtain pre-authorization for services to PBH members.
