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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.

A new Cerner Community Behavior Health (CCBH) EHR Training Tips and Resources page is now available for providers and Program Managers.

For Behavioral Health Services Provider Communications and Local information on COVID-19 Please visit the County OF San Diego Webpage.Coronavirus Disease 2019 COVID-19

COVID-19

Latest Update

BHS Provider Notice

Reporting Guidance

Other COVID-19 Resources and Updates

NOABD

NOABD Webinar available online.

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
NOABD Denial Notice ENGLISH (doc)
2020-06-16
NOABD Payment Denial Notice SPANISH (docx)
2020-06-16
NOABD Table (pdf)
Revised 01/08/2020 2020-01-08
NOABD Termination Notice - SPANISH (doc)
2020-05-08
SanWITS NOABD
SanWITS NOABD

Beneficiary

SD Grievance - Appeal Brochure - Vietnamese (pdf)
Revised 08/27/2021 2022-03-30
SD Grievance - Appeal Brochure - Arabic (pdf)
Revised 08/27/2021 2022-03-30
SD Grievance - Appeal Brochure - English (pdf)
Revised 08/27/2021 2022-03-30
SD Grievance - Appeal Brochure - Farsi (pdf)
Revised 08/27/2021 2022-03-30
SD Grievance - Appeal Brochure - Spanish (pdf)
Revised 08/27/2021 2022-03-30
SD Grievance - Appeal Brochure - Tagalog (pdf)
Revised 08/27/2021 2022-03-30
Quick Guide To MH Services-Vietnamese (pdf)
Revised 08/27/2021 2022-03-17
Quick Guide To MH Services-Farsi (pdf)
Revised 08/27/2021 2022-03-17
Quick Guide To MH Services-Spanish (pdf)
Revised 08/27/2021 2022-03-17
Quick Guide To MH Services-English (pdf)
Revised 08/27/2021 2022-03-17
Quick Guide To MH Services-Arabic (pdf)
Revised 08/27/2021 2022-03-17
Quick Guide To MH Services-Tagalog (pdf)
Revised 08/27/2021 2022-03-17
Beneficiary Materials MHP Order Form (docx)
Revised 02/10/2022 2022-03-17
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 7-1-18 Farsi (docx)
2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Arabic (docx)
2021-09-14
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 – CCHEA OP Advocacy 6-28-18 Vietnamese (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 - Vietnamese (docx)
2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Tagalog (docx)
2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Spanish (docx)
2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - English (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
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
San Diego Provider List Translation Instructions (pdf)
2021-07-19
MHP Beneficiary Handbook Cover in Threshold Languages (pdf)
Revised 07/10/2019 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
Beneficiary_Non-Discrimination_Notice_-_TAGALOG.docx
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
Advance_Directive_Farsi.pdf
2018-02-28
Notice of Privacy Practices - Farsi (pdf)
2018-02-13
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
Advance_Directive_Spanish.pdf
2015-10-09
Advance_Directive_English.pdf
2015-10-09

Communications

2022-02-11-BHS Contractor Memo-Medi-Cal RX Update dbc (docx)
2022-03-15
2021-11-10-BHS Contractor Memo-Medi-Cal RX 2021 (pdf)
2021-11-15
2021-06-29-BHS Information Notice-CYF Utilization Management Reinstated Effective 7.1.21 (pdf)
Effective July 1, 2021 2021-06-30
System of Care (SOC) Application - (BHS) – Contractor Information Notice (pdf)
11/23/2020 2020-11-30
Medication Assisted Treatment (MAT) Referrals (pdf)
2020-08-27
ASJ Memo 8-5-2020 (docx)
2020-08-05
ASJ Tip Sheet 8-5-2020 (docx)
2020-08-05
QM Memo ICD-10 7-16-20 (pdf)
2020-07-17
3/19/20 BHS Provider Notice #3- COVID 1- Quality Improvement Updates and Best Practices (pdf)
2020-03-20
QM Memo - EBP Indicator Removal for Homework & Child Family Team Meetings (docx)
Issued 02/06/2020 2020-02-07
QM MEMO - NOABD Logs (pdf)
Issued 01/31/2020 2020-01-31
QM MEMO - Medication Monitoring (pdf)
Issued 01/31/2020 2020-01-31
QIP Texting Presentation (pptx)
2020-01-21
CYF MEMO - Updated Ancillary SMHS Request Form (pdf)
Effective 1/1/2020 2020-01-10
CYF Memo Prior Auth for Day Services (pdf)
Effective 1-1-2020 2020-01-10
QM MEMO - CSI Diagnosis errors (pdf)
Issued 12/26/2019 2019-12-30
CYF MEMO - Utilization Management Outpatient Cycle Expansion (pdf)
Issued 12/20/2019 2019-12-30
QM Memo - DHCS Revised Telehealth Policies (docx)
Issued 12/06/2019 2019-12-09
QI - PIT MEMO - SOC Application (pdf)
2019-11-04
Optum San Diego Website MH Provider Registration Instructions (pdf)
2019-11-04
CYF MEMO – Revised UM Request Form (pdf)
Issued 09/03/2019 2019-09-06
CYF MEMO – IHBS Prior Authorization 08/16/19 (pdf)
2019-08-20
CYF Memo – TBS Prior Authorization Process (pdf)
Issued 7/29/19 2019-08-14
QM MEMO - New BHS 025 Forms (docx)
2019-04-24
QM MEMO - New Updated Discharge Form - 4.4.19 (pdf)
2019-04-12
CYF MEMO - Revised CANS Sharing Confirmation 3.26.19 (pdf)
2019-04-09
QM MEMO – PROSPECTIVE RISK ANALYSIS – 02.07.19 (docx)
2019-02-08
QM MEMO – PROSPECTIVE RISK ANALYSIS – 02.14.19 (doc)
2019-02-08
QM MEMO - Prospective Risk Analysis (docx)
2019-01-09
QM MEMO_-_New_Non-Bill_Other_Support_Service_Code_01_29_18.pdf
2018-11-29
QM MEMO - Patient_Advocacy Services for BHS - Record Requests 11 01 18 (pdf)
2018-10-31
QM MEMO - Privacy - Confidentiality Legislative Updates 10.23.18 (docx)
2018-10-24
QM MEMO_-_Specialty_Mental_Health_Service_Claiming_for_ES-HS_9_7_18.pdf
2018-10-08
Intensive_Service_Request_ISR_CYF_Memo_04-1617.pdf
2017-06-30
QM MEMO - Specialty Mental Health Service Claiming for ES-HS (pdf)
2018-09-10
QM MEMO – Billing for C-practitioners 07 02 18 (docx)
2018-07-13
QM MEMO – AOA Outpatient Utilization Management 06 29 18 (pdf)
2018-07-13
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 - Controlled Substance - CURES Mandate (pdf)
2018-06-08
QM_MEMO_-_New_Auth_to_Use-Disclose_Multiple_Form_051513.pdf
2017-05-12
QM_MEMO_-_Client_Plan_Redesign_6-20-17.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_-_New_Evidence_Based_Practice_Indicators_06_23_17.pdf
2017-06-27
QM_MEMO_-_Allowed_Services_Prior_to_Client_Plan_Completion_-_DHCS_Guidelines_6_20_17.pdf
2017-06-21
QM Memo - New Billing Indicators - Intrepreter and Language 06-08-17 (pdf)
2017-06-14
QM_MEMO_-_Day_Treatment_Interim_Folder_03_29_17.pdf
2017-03-31
QM_MEMO_-_Place_of_Service_Update_03_30_17.pdf
2017-03-31
QM_MEMO_- 42_CFR_Final_Rule_1-26-17.pdf
2017-02-02
QI_MIS_MEMO_2016_12_01_CCBH_Client_Attachments.pdf
2018-05-25
QI_MIS_MEMO_2016_10_31_CCBH_Demographic_Form_Table_Change.docx
2016-11-03
QI_MIS_MEMO_2016_05_09_CCBH_Outside_of_the_Office_Update.pdf
2016-05-11
QM_MEMO_-_Day_Tx_Program_-_Updated_Standards.5.1.16.docx
2016-05-11
QI_MIS_MEMO_2015_11_20_Saving_Reports_to_a_SpreadsheetProcess_and Policy.pdf
2015-11-30
QM_MEMO_DHP_4_14.pdf
2015-10-09
QM_MEMO_-_Reaffirming_DHCS_Day_Treatment_Standards_08_26_14.docx
2015-10-09
QM_MEMO_-_New_Interactive_Add_On_Service_Code_785_9_22_14.docx
2015-10-09
QM_MEMO_-_Documentation_Guidelines_when_EHR_Unavailable_9_04_14.docx
2015-10-09
QM_Memo_-_90_Day_Lockout_Process_Update_11_06_13.pdf
2015-10-09
QI_MIS_MEMO_2014_1_09_Notifications_in_Anasazi.pdf
2016-05-16
FAQ_-_Request_for_Servcies_Log_-_Access_Time_Report_-_9-30-14_.pdf
2016-07-15
QM Memo - CPT Coding Changes 2013 (pdf)
2016-07-15
QM Memo - LPCC Credential Under MHP 07 24 13 (doc)
2015-10-09
QM Memo - Holder of Records 01 03 13 (pdf)
2016-07-15
CSI Requirement for MH Programs 08 27 12 (pdf)
2016-07-15

Forms

5150 Form (pdf)
2021-05-10
72 Hour Post Discharge Log (pdf)
2017-03-23
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
Access to Services Log (xlsx)
2018-06-20
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 of Findings (docx)
2022-04-11
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
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
JV220(A) - Physician's Statement - Attachment (pdf)
2018-03-01
JV220(B) - Physican's Request to Continue Medication - Attachment (pdf)
2018-03-01
MAA Service Record (pdf)
2017-08-24
Med Mon McFloop Form (docx)
Revised 01/17/2020 2020-01-31
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)
2021-09-17
Medi-Cal Administrative Activities (MAA) Procedures
2017-08-24
Medication Disposal Log (pdf)
2021-06-03
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
QIP Follow up Form FY 20-21 (docx)
2020-08-07
Reestablishment Recommendation Form (doc)
2021-03-12
Request for Verification of Veterans Eligibility (pdf)
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
Written Translation Service Authorization Form (pdf)
2021-03-12

Manuals

OPOH

01 - Cover Sheet Org Provider Manual (pdf )
2018-09-20
02 - Table of Contents Org Prov Op Handbook (pdf)
Revised 12/22/2021 2021-12-28
03 - OPOH - Customer Service Mission (pdf)
Revised 04/08/2020 2020-04-09
04 – OPOH – Section A – System of Care (pdf)
Revised 03/11/20222 2022-03-21
05 - OPOH - Section B - Compliance Confidentiality (pdf)
Revised 06/15/2021 2021-06-21
06 – OPOH – Section C – Accessing Services (pdf)
Revised 03/11/2022 2022-03-17
07 – OPOH – Section D – Providing Specialty Mental Health Services (pdf)
Revised 03/11/2022 2022-03-17
08 - OPOH - Section E - Integration With Physical Healthcare (pdf)
Revised 06/14/2021 2021-06-15
09 – OPOH – Section G – Quality Improvement (pdf)
Revised 03/11/2022 2022-03-17
10 - OPOH - Section F - Beneficiary Rights Grievance Appeals (pdf)
Revised 03/04/2022 2022-03-07
11 – OPOH – Section H – Cultural Competency (pdf)
Revised 8/27/2021 2021-09-01
12 - OPOH - Section I Management Info System (pdf)
Revised 02/21/2020 2020-03-02
13 - OPOH - Section J - Provider Contracting (pdf)
Revised 04/13/2021 2021-04-14
14 - OPOH - Section K - Provider Issue Resolution (pdf)
Revised 02/19/2020 2020-03-02
15 - OPOH - Section L - Practice Guidelines (pdf)
Revised 03/11/2022 2022-03-17
16 – OPOH – Section M – Staff Qualifications (pdf)
Revised 03/28/2022 2022-03-29
17 - OPOH - Section N - Data Requirements (pdf)
Revised 03/11/2022 2022-03-17
18 - OPOH - Section O - Training (pdf)
Updated 10/23/2019 2019-11-07
19 - OPOH - Section P - Mental Health Services Act (pdf)
Revised 03/11/2022 2022-03-17
20 – OPOH – Section Q – Payment Schedule and Budget Guidelines (pdf)
Revised 10/05/2021 2021-10-06
21 - OPOH - Section R - Quick_Reference (pdf)
2019-05-22
030 - OPOH - Appendix C - A.C.2 - AMHS - Walk-in Clinics Hours Contacts (pdf)
2019-07-18
031 - OPOH - Appendix C - A.C.3 - Transition Age Youth Referral Form (pdf)
Revised 04/15/2014 2016-07-13
032 - OPOH - Appendix C - A.C.4 - Transtion Age Youth Referral Plan 4-15-14 (pdf)
Revised 04/15/2014 2016-07-13
057 - OPOH - Appendix E - A.E.2 – HSD Plan Partner Card (pdf)
2020-02-20
058 - 00 - OPOH - Appendix E - A.E.3 - Plan Partner Identification for Pharmacies (pdf)
2016-07-13
105 - OPOH - Appendix K - A.K.1 - Formal Complaint by Provider Form (pdf)
2016-07-13
106 - OPOH - Appendix K - A.K.2 - Formal Response To Complaint Form (pdf)
2016-07-13
107 - OPOH - Appendix K - A.K.3 - Formal Appeal by Provider Form (pdf)
2016-07-13
108 - OPOH - Appendix K - A.K.4 - Formal Appeal Response Form (pdf)
2016-07-13
109 - 01 - OPOH - Appendix L - A.L.1 - Monitoring Psychtropic Medications (pdf)
7-16-12 2016-07-13

Resources

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
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
EM 101 - CPT Coding Changes - 2013 (pdf)
2015-10-09
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 Instructions (ppt)
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
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 Instructions (ppt)
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 05/11/2022 2022-05-11
MRR Tool – FY 21-22 (xlsx)
Revised 02/24/2022 2022-05-03
Medi-Cal Certification-Recertification Tool (xls)
FY 22-23 2022-04-07
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
New Contractor Orientation Resources (docx)
Revised 06/22/2020 2020-06-23
Progress Note Checklist Table (pdf)
Checklist 2020-03-10
QI UPDATES MHP 7th ANNUAL 09.22.20 (pdf)
2020-10-08
QUALITY IMPROVEMENT KNOWLEDGE FORUM Presentation (pdf)
presented July 12, 2019 2019-07-18
Quality Improvement Annual Forum 2018 - Powerpoint (pptx)
07-25-2018 Presentation 2018-07-26
RCA WORKSHEET Sample (pdf)
2021-03-12
Reasons for Recoupment Changes Grid (docx)
Active 01/01/2022 2021-12-15
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

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

UTTM

QM...Up to the Minute - May 2022 (pdf)
2022 2022-05-13
QM...Up to the Minute - February 2022 (pdf)
2022 2022-02-10
QM...Up to the Minute - April 2022 (pdf)
2022 2022-04-15
QM...Up to the Minute - January 2022 (pdf)
2022 2022-01-25
QM...Up to the Minute - March 2022 (pdf)
2022 2022-03-30
QM...Up to the Minute - November 2021 (pdf)
2021 2021-11-12
QM...Up to the Minute - October 2021 (pdf)
2021 2021-10-14
QM...Up to the Minute - May 2021 (pdf)
2021 2021-05-17
QM...Up to the Minute - December 2021 (pdf)
2021 2021-12-13
QM...Up to the Minute -September 2021 (pdf)
2021 2021-09-10
QM...Up to the Minute - June 2021 (pdf)
2021 2021-06-10
QM...Up to the Minute - August 2021 (pdf)
2021 2021-08-12
QM...Up to the Minute - July 2021 (pdf)
2021 2021-07-08
QM...Up to the Minute - April 2021 (pdf)
2021 2021-04-09
QM...Up to the Minute - March 2021 (pdf)
2021 2021-03-12
QM...Up to the Minute -February 2021 (pdf)
2021 2021-02-12
QM...Up to the Minute - January 2021 (pdf)
2021 2021-01-15
QI...Up to the Minute - FY 2019 -2020 (pdf)
2020 2020-07-31
QM...Up to the Minute - February 2020 (pdf)
2020 2020-02-13
QM...Up to the Minute - January 2020 (pdf)
2020 2020-02-13
QM...Up to the Minute - September 2020 (pdf)
2020 2020-09-11
OM...Up to the Minute - May 2020 (pdf)
2020 2020-05-15
QM...Up to the Minute - April 2020 (pdf)
2020 2020-04-09
QM...Up to the Minute - August 2020 (pdf)
2020 2020-08-13
QM...Up to the Minute - December 2020 (pdf)
2020 2020-12-16
QM...Up to the Minute - July 2020
2020 2020-07-10
QM...Up to the Minute - June 2020
2020 2020-06-12
QM...Up to the Minute - March 2020 (pdf)
2020 2020-03-31
QM...Up to the Minute - November 2020 (pdf)
2020 2020-11-12
QM...Up to the Minute - October 2020 (pdf)
2020 2020-10-09
QM...Up to the Minute - October 2019 (pdf)
2019 2019-10-10
QI...Up to the Minute - June 2019 (pdf)
2019 2019-07-11
QI...Up to the Minute - April 2019 (pdf)
2019 2019-04-12
QI...Up to the Minute - August 2019 (pdf)
2019 2019-08-14
QI...Up to the Minute - FY 2018-2019 (pdf)
2018-2019 2019-09-24
QI...Up to the Minute - February 2019 (pdf)
2019 2019-02-15
QI...Up to the Minute - January 2019 (pdf)
2019 2019-01-10
QI...Up to the Minute - March 2019 (pdf)
2019 2019-03-14
QI...Up to the Minute - May 2019 (pdf)
2019 2019-05-10
QM...Up to the Minute - December 2019 (pdf)
2019 2020-02-13
QM...Up to the Minute - July 2019 (pdf)
2019 2019-07-23
QM...Up to the Minute - November 2019 (pdf)
2019 2019-11-20
QM...Up to the Minute - September 2019 (pdf)
2019 2019-09-24
QI...Up to the Minute - August 2018 (pdf)
FY18-19 2021-06-10
QI...Up to the Minute - December 2018 (pdf)
FY18-19 2021-06-10
QI...Up to the Minute - July 2018 (pdf)
FY18-19 2021-06-10
QI...Up to the Minute - November 2018 (pdf)
FY18-19 2021-06-10
QI...Up to the Minute - October 2018 (pdf)
FY18-19 2021-06-10
QI...Up to the Minute - September 2018 (pdf)
FY18-19 2021-06-10

Training


Training Classes Video Tutorials and Resource Packets


Progress Note Correction Resources


Other Training Resources and Tip Sheets

Covid-19 Dashboard Tutorial available online (new)
Claim It Anyway (CIA) Webinar available online (new)
Access to Services Journal Video Tutorial available online.
Progress Notes and Service Codes Webinar available online 
NOABD Webinar available online
Service Indicators Webinar available online
BHA Webinar available online
Client Plan Webinar available online

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 (docx)
Revised 04/01/2022 2022-03-25
STRTP PRIOR AUTHORIZATION DAY SERVICES REQUEST - EXPLANATION (docx)
Revised 04/01/2022 2022-03-25
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

TFC

ANNUAL TFC PARENT EVALUATION FORM FILL (docx)
2020-11-25
ANNUAL TFC PARENT EVALUATION – EXPLANATION (pdf)
2020-11-25
ANNUAL TFC PARENT SELF -EVALUATION FORM FILL (docx)
2020-11-25
ANNUAL TFC PARENT SELF-EVALUATION FORM – EXPLANATION (pdf)
2020-11-25
BHS Contractor Memo-TFC Forms Effective December 2020 (pdf)
Memo - 11/23/2020 2020-11-25
CCBH TFC DAILY PROGRESS NOTE FORM FILL (doc)
2020-11-25
TFC ANNUAL PARENT AGREEMENT AND CERTIFICATION FORM FILL (docx)
2020-11-25
TFC CLINICAL DOCUMENTATION TIP SHEET (pdf)
2020-11-25
TFC DAILY PROGRESS NOTE- EXPLANATION (pdf)
2020-11-25
TFC PARENT DOCUMENTATION TIP SHEET (pdf)
2020-11-25
TFC PRIOR AUTHORIZATION REQUEST (docx)
Revised 04/01/2022 2022-03-25
TFC PRIOR AUTHORIZATION REQUEST - EXPLANATION (docx)
Revised 04/01/2022 2022-03-25

Peer Support Specialist

BHS HPA Peer Support Specialist Services Q and A (pdf)
Updated 05/18/2022 2022-05-20
Certified Peers (pdf)
Updated 03/2022 2022-05-16
Scholarship Flyer_Peer Support Specialist Certification Program (pdf)
2022-05-13
BHS Contractor Memo - BHS Peer Support Specialist Certification Program (pdf)
10/05/2021 2021-10-08

Billing Unit/Finance

Billing Unit Manuals

Billing Unit Resources

Billing Unit Forms