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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
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
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
Recipient Rights
ORR stands for Office of Recipient Rights. This office is mandated into existence by a law known as the Michigan Mental Health Code (MMHC) for any Community Mental Health Service Program (CMHSP), Licensed Private Hospital/Unit (LPH/U), or state-operated psychiatric facility. Its primary function is to ensure that the rights of recipients of mental health services, guaranteed under the MMHC, are protected. This is done through investigation, monitoring and prevention.
FAQ
Q. Who is required to abide by the MMHC law?
A. Any CMHSP, LPH/U or state psychiatric hospital employee or their contract providers.
Q. What form do I use to file a complaint?
A. Recipient Rights Complaint Form
Q. What is expected of staff when a rights investigation is initiated?
A. All direct operation or contract provider staff must cooperate fully with a rights investigation as a condition of their employment.
Q. Do employees have any appeal rights under the MMHC with regard to ORR investigative findings?
A. Not at this time.
Q. What if I report a violation and then my employer retaliates against me?
A. It is prohibited for someone to retaliate or harass against the reporter. A person who has been harassed or retaliated against can also pursue their grievance through the Whistleblower Protection Act.
Q. Why do recipients of mental health services get “extra rights”?
A. A recipient does not receive “extra rights;” they have protected rights. Protected rights are provided to those who receive public mental health services.
ISK Policy
Recipient Rights
Rights Complaints and Dispute Resolution
Information Technology
The Information Technology Services (ITS) department:
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- 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.
- Provides specialized application development services including the creation of reports.
- 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:
- 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.
- Send an email to helpdesk@iskzoo.org.
- Call the Helpdesk at (269) 553-8059.
- 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.