Introduction	About PacifiCare Behavioral Health PacifiCare Behavioral Health - Mission and Vision About This Manual Member Rights and Responsibilities
Clinical Services	Assessment and Triage Eligibility Verification How a Member Accesses the PBH Benefit The Referral Process Emergency Services Emergency Situations Requiring Hospitalization Concurrent Review Second Opinion EAP Services
Outcomes Management	ALERTSM Annual Report January 2001 History and Overview Alert Outcome Measures Treatment Outcomes Treatment Sample The Results Measuring Change from Phone Intake to Treatment Follow-Up Cases at Risk for Poor Outcomes Identification of Patients at Risk for Suicide and/or Substance Abuse Preferred Group Practice Results A Practitioner?s Guide to the ALERT System
Provider Guidelines	PBH - Provider Relationships Provider Standards of Practice PBH Network Provider Responsibilities Credentialing/Recredentialing for Independent Practitioners Documentation Requirements Requirements for Submission to PBH PBH and NCQA Requirements for Treatment Records and Clinical Documentation Treatment Record Audits Specialized Service Procedures
Inpatient Care Guidelines	Pre-Authorization/Authorization Inpatient Eligibility and Accessibility Utilization Management Inpatient Care Management Facility Credentialing/Recredentialing Medical Staff Billing and Reimbursement Non E.R. Admits Through Emergency Departments Emergency Referrals
Employee Assistance Program (EAP)	About the PBH EAP Types of EAP Service Plans and Care Management Requirements Formal Supervisor Referrals Critical Incident Debriefing Crisis Intervention Follow-Up Training Community Resources Accessibility Documentation Requirements Billing and Reimbursement
Coordination and Continuity of Care	Coordination of Care with Primary Care Physicians (PCPs) Coordination of Care Within Behavioral Health Continuity of Care PBH Outpatient Prescription and Laboratory Policies
Quality Improvement	Quality Improvement Program Quality Improvement Activities Risk Management and Patient Safety Primary Quality Improvement Responsibilities of PBH Providers Preventive Behavioral Health Programs Provider Profiles
Utilization Management	Utilization Management Program Utilization Management Activities Financial Incentives for UM Decision-Making Provider Dispute Resolution Process (West, Oregon & Washington) Provider Dispute Resolution Process (Southwest and Colorado Only) Clinical Reviewer Available to Discuss Denials New Technology Assessment
Technology and Use of the Internet	About PacifiCare Behavioral Health Online Confidentiality and Responsibility - Your Tasks Keeping Internet Transactions Secure - Our Tasks Frequently Asked Questions and Answers Internet Terminology
The PBH Clinical Models	Introduction The PBH Multi-Level Model of Care Management References
Administrative Guide	Introduction Communicating Changes Change Of Address/Information How a PBH Member is Referred to a Provider No-Show Policy Recommendations No-Show Sample Form Clinical Documentation Requirements PBH Outpatient Prescription and Laboratory Policies Billing, It's As Easy As Required Billing Information For 1500 Health Insurance Claim Form (HICF)  Sample 1500 Health Insurance Claim Form (HICF) Form Sample UB92 Form Reimbursement Issues Sample of Request for Billing Information Coordination of Benefits Sample: COB Dependent Inquiry
Index of Forms	Fax Forms Library Sample Forms (For Duplication)