ISK Provider Manual

Provider Network Management

The Provider Network is the entire body of people, clinics, hospitals, and agencies that ISK contracts with to help it achieve its mission. The local healthcare providers that ISK contracts with provide all services that are not directly provided by ISK staff. ISK values its strong and diverse network of providers and is constantly working to increase the network’s strength and to fill in any gaps in its service array.

FAQ
Q. I was denied payment for a service that I provided to an ISK consumer.
A. You can file an appeal on any denial. Complete this Provider Appeal form and submit it for review.

Q.  As part of contract compliance, I was asked to fill out a “Plan of Correction.”
A.  Use this Plan of Correction to submit to your response.

Q.  Where can I find out about required trainings for my agency and staff?
A.  This Training Requirement Chart lays out who needs to take what trainings and when.

Q.  What kind of monitoring processes and reviews will I be subject to as a ISK provider?
A.  This Provider Monitoring Matrix explains the kind of reviews and monitoring you can expect.

Q.  What qualifications or credentials do I need to have to provide a particular service, like psychotherapy or case management, to a consumer?
A. The Michigan PIHP/CMHSP Provider Qualifications Per Medicaid Services & HCPCS/CPT Codes spells out what is required by the Michigan Mental Health Code.

ISK Policy
Provider Network Management Policy

Service and Supports

Practice Guidelines ISK Policies

• Utilization Management and Access
• Clinical Practices
• Intake and Assessment
• Consumer Planning
• Service Coordination
• Transition, Discharge and Follow Up
• Records of Individuals Served
• Record Retention

Finance/Claims

Description
The finance department manages everything to do with the flow of money through the agency, including the billing processes.  Finance ensures, among other things, that ISK providers are paid for the services they provide at the correct time, in the correct amount, and from the correct funding sources.

FAQ
Q.  Who do I contact if I have problems getting my claim paid, (i.e., missing authorizations, incorrect contract rate)?
A.   If you have problems or questions about claims, please contact the financial analyst associated with your population. ISK has financial analysts who specialize in each population (MIA, I/DD, SED, SUD).  Just call 553-8000 and ask to talk to your population analyst.

Q.  How do I appeal a denied claim?
A.  See Provider Grievance and Appeals (non-clinical) Policy  Appeal Form

Q.  How do I enter a new claim into KARE?
A.  You can enter a new claim into KARE by following the step-by-step instructions explained in this document — NEW CLAIM ENTRY

Q.  How do I submit billing via 837?
A.  You can submit billing via 837 by following the step-by-step instructions explained in this document — 837 COMPANION GUIDE

ISK Policy
Financial Management Claims Management — Ability to Pay (ATP)
Grievance and Appeals Procedure

CCBHC Sliding Fee Discount Program

CCBHC Sliding Fee Discount Program Scale

Corporate Compliance

The Corporate Compliance Office is charged with developing and managing the Compliance Program for ISK and its provider network.

The primary roles of the office are:

• To ensure ISK has a functional Compliance Program that meets all federally mandated essential elements and that regulatory and statutory compliance is adhered to across the provider network.
• To ensure ISK maintains a comprehensive risk management system that monitors key functions across the provider network, identifies potential risk areas, provides recommendations and solutions for remediation, and monitors the system for systemic compliance and risk management concerns.

The office is also available to assist anyone wanting to report alleged Fraud, Waste and Abuse in the Medicare/Medicaid system.  Reporting can be made in various ways.  Employees have a duty to report concerns, compliance is everyone’s responsibility. 

FAQ
Q.  What is the Corporate Compliance Hotline?
A.  You may report alleged fraud 24 hours a day, seven days a week by telephone at (866) 939-4823, or during business hours (269) 364-6985. You may also send an email to compliance@iskzoo.org.  Click here for a posting for your organization.

Q.  Who can file a report?
A.  Anyone who believes or has evidence that fraud, waste, or abuse to ISK may have occurred or is occurring should file a report.

Q.  May I remain anonymous?
A.  Yes, you may remain anonymous. The Compliance Office strictly honors confidentiality and will not reveal the identity of any informant or source of information without the informant’s authorization or by order of a court of law.

Q.  What can be reported?
A.  Any kind of fraud or misconduct can be reported related to Medicare/Medicaid funding. You may report any employee, contractor, or vendor who may be committing fraud, or any practice or act you observe that results in the abuse or waste of Medicare/Medicaid resources.

Q.  What information should I provide when filing a report?
A.  When reporting suspected fraud, please provide as much information and detail as possible, including who, what, when, where, why, and how.

In general, please provide the name of the person(s) involved; explain what is happening and where and when the fraud occurred.  Provide as much information as possible.  If you are aware of misconduct, any information you have is helpful.  If you have documents available, please provide them.

Q.  When I call the hotline, am I being recorded?
A.  No. We do not record calls made to the hotline.

ISK Policy 
Corporate Compliance — Complaint and Investigation Process

Quality Management and Contract Services

The Quality Management Department encompasses activities directed at ensuring that standards of staff, program, and management performance exist, that compliance with them is assessed, and that ongoing improvements are introduced and assessed. The components of Quality Management include:

• Developing and maintaining an effective quality assessment and improvement program that meets MDHHS and other requirements.
• Standard setting, which includes performance expectations for both clinical and management programs and ensuring that there are adequate standards in place for credentialing/re-credentialing, eligibility for services, and practice guidelines.
• Conducting performance assessments, which include the collection and analysis of performance data, stakeholder surveys on their perception of service quality and performance improvement projects.
• Conducting on-site monitoring of services and providers within the provider network.
• Managing outside agency review processes such as MDHHS site reviews, PIHP reviews, and accrediting body reviews.
• Providing oversight of the adequacy of staff and provider education and training.
• Analyzing critical incidents and sentinel events.

Q.  Why does ISK complete reviews of our clinical records, claims, and organization every year?
A.  The State and Federal Government state that ISK will be accountable and oversee subcontractors and will monitor the subcontractor’s performance on an ongoing basis (42 CFR & PIHP Contract).

Q.  Why do I have to complete Incident Reports?
A.  MDHHS requires ISK to follow up on all sentinel events and critical incidents that put people at risk of harm and to report specific events directly to MDHHS. The CMHSP also uses this information to make system improvements.

Q.  What do I need to do if someone I am providing services to dies?
A.  The Death Report explains what the provider needs to do and contains a copy of the forms to be completed.

Q.  Why do Children’s Therapists need to complete 24 hours of Children’s Training?
A.  MDHHS requires all mental health professionals who work with children to complete 24 hours of children-specific training annually and suggests that no more than 8 hours be completed electronically (Children’s Diagnostic and Treatment Services Program).

Q.  Why does ISK require annual trainings for providers?
A.  To promote quality services and desired outcomes for persons served and to meet State and Federal requirements. Training requirements are specified in the contract signed within Section 2.2 of the contract agreement.

ISK Policy
Quality Improvement — Performance Indicators

Customer Service

Customer Services for ISK is available by contacting us at 610 S. Burdick Street in Kalamazoo. The telephone numbers are (269) 553-7000 or (877) 553-7160. The primary responsibilities of Customer Services for ISK are to:

• Provide an initial welcome and an orientation of the services and benefits available through the community mental health and substance use service system, as well as an overview of the network of providers in our service system.
• Provide information about how to access mental health, substance use, primary health, and other community services.
• Provide information about how to access the processes that are in place to protect the rights of the people we serve. This includes providing assistance to file grievances, complaints, or appeals.
• Provide assistance with questions and problems about community benefits.

FAQ
Q. Where do I find the Handbook?
A. You can print the entire book or any necessary handouts by clicking on Customer Handbook. This link leads you to the SWMBH website where you can always have access to the most current version of the Customer Handbook as well as the Spanish versions. Once there, click on the blue “Member Documents” drop-down menu bar then select the version of the handbook you wish to access. You can also contact customer service at (269) 553-7000.

Q. If I have a question about if a Notice of Adverse Benefit Determination (ABD) is necessary, where to I start?
A. Please start with the Utilization Management Specialist for your program. Other process questions can be directed to ISK Customer Services. If access to KARE is not available, the current ABD forms can be accessed through the portal under policy/procedure 06.02.01 or by contacting the Customer Services office at (269) 553-7000 to request the approved alternative versions. You can access instructions for ABD completion from the Help Section within KARE.

Q.  How do I get training regarding Action Notices and/or Customer Appeals?
A. Training is provided on the 3rd Wednesday of each month through the ISK Training Center. Please sign up for this session as you do for other sessions with the ISK Training Department. If you have a question about how to complete an ABD for particular customer, please contact your Utilization Management Specialist or Customer Services.

Q. How can I help a customer appeal a service decision?
A. Please direct the customer to the ISK Customer Services office.  You can help them to call us or to access our CS office via our web page. If a customer wants you to help them to appeal, first inform your supervisor of this request. You can provide assistance via phone or from our web page. The customer will need to give you written/signed permission to speak “for them.”

ISK Policy
Customer Service
ABD Centralization Process

Performance Improvement

1. ISK Strategic Goals (FY 18/20)
2. ISK Strategic Goals – Updates/Progress (FY 16/17)
3. Provider Survey Results (2016)

Information Technology

The Information Technology Services (ITS) department:

1. 1. Manages and maintains all computer systems owned by ISK. This includes data center hardware and software, desktop and laptop computers, cell phones, and air cards.
   2. Provides specialized application development services including the creation of reports.
   3. Provides helpdesk functions to support hardware and software applications and systems.

For our contract providers, ITS supplies and supports the Streamline applications (SmartCare and Provider Access) for clinical and billing functions. These systems include a secure method of communication and should always be used when discussing client information – as opposed to sending protected health information (PHI) using regular email, which is strictly forbidden.

ITS also provides the portal which is heavily used as a document library and collaboration tool. Providers can access the Portal to find policies, forms, and reports.

Q. How do I contact the Helpdesk?
A. There are four ways that you can use to contact the ITS Helpdesk:

1. Submit a new Helpdesk ticket using the Helpdesk application by clicking here. Please note that in order to do this, you will need a login account to the Portal. This is a great option because your request will be tracked.
2. Send an email to helpdesk@iskzoo.org.
3. Call the Helpdesk at (269) 553-8059.
4. Contact your provider network manager. They will be able to convey your needs/issues to the ITS Helpdesk and even create a ticket on your behalf.

Q. How do I submit a Portal login request?
A. Requesting a Portal login account is as easy as filling out a “Portal Login Request” form and sending it to the ITS Helpdesk via email. Please note that this form requires that your organization have an NPI number.

Q. How do I get a Streamline login account?
A. In order to obtain a Streamline login ID and password, you need to submit a “Streamline User Request” form to your provider network manager.  Once they validate the request, they will forward it to ITS.