MHP Provider Documents

COVID-19

Latest Update

2021-06-29-BHS Information Notice-CYF Utilization Management Reinstated Effective 7.1.21 (pdf)

Coronavirus Disease 2019
COVID-19 FAQs for BHS Providers
How to Manage Your Mental Health and Cope During COVID-19
CA Health Alert Network (CAHAN)

BHS Provider Notice

Notice # 1 - BHS Provider Notice - COVID-19 (pdf)
Notice #2 - BHS Provider Notice - COVID-19 - Guidance and Best Practices (pdf)
Notice #3 - BHS Provider Notice - COVID-19 - Quality Improvement Updates and Best Practices (pdf)
Notice #4 - BHS Provider Notice - COVID-19 - Financial Practices and Contract Management Updates (pdf)

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


MHP Beneficiary Handbook English (pdf)	Effective 03/12/2023	2023-03-10


MHP Beneficiary Handbook_2.2023_Tagalog.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Spanish.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Korean.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Persian(Farsi).pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Arabic.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Vietnamese.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Dari.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Somali.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Chinese.pdf	Effective 03/12/2023	2023-03-10


Physician Notice to Patients California Regulation - Arabic (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Chinese (pdf)		2023-05-09
Physician Notice to Patients California Regulation - English (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Farsi (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Korean (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Spanish (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Tagalog (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Vietnamese (pdf)		2023-05-09
Advance Directive - Farsi (pdf)		2023-05-04
Advance Directive – Arabic (pdf)		2023-05-04
Advance Directive - Dari (pdf)		2023-05-04
Advance Directive – Tagalog (pdf)		2023-05-04
Advance Directive – Spanish (pdf)		2023-05-04
Advance Directive – Vietnamese (pdf)		2023-05-04
Advance Directive – English (pdf)		2023-05-04
Advance Directive - Korean (pdf)		2023-05-04
Advance Directive – Chinese (Traditional) (pdf)		2023-05-04
Advance Directive – Somali (pdf)		2023-05-04
Limited English Proficiency Poster – Chinese (Traditional)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Spanish (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Korean (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Tagalog (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Dari (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Somali (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Vietnamese (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Arabic (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Farsi (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – English (pdf)	Revised 04/2023	2023-05-02
Open Payments Database Notice to Clients Display (docx)	Link	2023-05-01
Open Payments Database Physician Notice to Clients (docx)	Revised 01/19/2023	2023-05-01
CA Board of Psychology Consumer Statement - Korean (pdf)		2023-05-01
CA Board of Psychology Consumer Statement - Chinese (pdf)		2023-05-01
BBS Required Notice to Consumers 2022 (pdf)		2022-05-25
ACL Poster - Vietnamese (pdf)		2023-02-24
ACL Poster - Tagalog (pdf)		2023-02-24
ACL Poster - Arabic (pdf)		2023-02-24
ACL Poster - English (pdf)		2023-02-24
ACL Poster - Farci (pdf)		2023-02-24
ACL Poster - Spanish (pdf)		2023-02-24
01 - MHP Beneficiary Handbook Summary of Changes (pdf)	Revised February 2023	2023-02-09
San Diego Provider List Translation Instructions (pdf)		2021-07-19
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
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
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
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
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
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

Communications


2023-05-19-BHS Provider Memo-Payment Reform CPT for SMHS (pdf)		2023-05-19
2023-04-20 – BHS Contractor Memo-TAY CANS (pdf)		2023-05-04
2023-05-01- BHS Contractor Memo- Open Payments Database (pdf)	Memo	2023-05-01
2023-02-22 – BHS Provider Memo – Screening and Transition Tool (docx)		2023-02-23
Revised 2023-2-8-BHS and Probation Care Coordination Directive_.pdf		2023-02-16
Day Treatment CalAIM and Contract Requirement Updates Memo 11.17.22 (docx)		2022-12-02
BHS Contractor Memo – CalAIM Documentation Reform (docx)	08/15/2022	2022-08-25
2022-06-21 – BHS Info Notice – Utilization Management (UM) Update (pdf)		2022-06-24
BHS Contractor Memo-CalAIM Documentation Reform	05/22/2022	2022-05-24
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)	Revised 10/27/2022	2022-11-10
BHS Serious Incident Report Explanation (pdf)	Revised 07/01/2022	2022-07-01
BHS Serious Incident Report of Findings (docx)	Revised 07/07/2022	2022-07-22
BHS Serious Incident Report of Findings Explanation (pdf)	Revised 07/08/2022	2022-07-22
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
DPC 203 and 204 Forms (docx)		2023-02-07
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 01/12/2023	2023-01-13
Med Monitoring Submission Form - Childrens (xlsx)	Revised 04/24/2023	2023-04-28
Med Monitoring Tool AOA (docx)	Revised 10/26/2022	2022-10-26
Med Monitoring Tool CYF (docx)	Revised 10/26/2022	2022-12-09
Medi-Cal Administrative Activities (MAA) Procedures		2017-08-24
Medication Disposal Log (pdf)		2021-06-03
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
Transition of Care Tool for Medi-Cal Mental Health Services (pdf)		2023-02-28
Transition of Care Tool for Medi-Cal Mental Health Services – Explanation Form (docx)		2023-02-28
Written Translation Service Authorization Form (pdf)		2021-03-12

Manuals

OPOH

OPOH - Organizational Providers Operation Handbook (pdf)


01 - Cover Sheet Org Provider Manual (pdf )		2018-09-20
02 - Table of Contents Org Prov Op Handbook (pdf)	Revised 09/06/2022	2022-09-08
03 - OPOH - Customer Service Mission (pdf)	Revised 04/08/2020	2020-04-09
04 – OPOH – Section A – Systems of Care (pdf)	Revised 09/01/2022	2022-08-15
05 - OPOH - Section B - Compliance Confidentiality (pdf)	Revised 06/15/2021	2021-06-21
08 - OPOH - Section E - Integration With Physical Healthcare (pdf)	Revised 06/14/2021	2021-06-15
06 – OPOH – Section C – Accessing Services (pdf)	Revised 04/11/2023	2023-05-17
07 – OPOH – Section D – Providing Specialty Mental Health Services (pdf)	Revised 04/03/2023	2023-05-23
09 - OPOH - Section F - Beneficiary Rights Grievance Appeals (pdf)	Revised 03/04/2022	2022-09-08
10 - OPOH - Section G - Quality Improvement (pdf)	Revised 04/03/2023	2023-05-17
11 – OPOH – Section H – Cultural Competency (pdf)	Revised 09/06/2022	2022-09-08
12 - OPOH - Section I Management Info System (pdf)	Revised 02/21/2020	2020-03-02
13 - OPOH - Section J - Provider Contracting (pdf)	Revised 05/09/2023	2023-05-16
14 - OPOH - Section K - Provider Issue Resolution (pdf)	Revised 02/19/2020	2020-03-02
15 – OPOH – Section L – Practice Guidelines (pdf)	Revised 04/03/2023	2023-05-17
16 – OPOH – Section M – Staff Qualifications (pdf)	Revised 07/01/2022	2022-07-26
17 - OPOH - Section N - Data Requirements (pdf)	Revised 04/21/2023	2023-05-17
18 - OPOH - Section O - Training (pdf)	Revised 04/03/2023	2023-05-17
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
MIS-25 Program Listing Report.xlsx
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)		2022-06-06
CCBH Report Uses for Program Integrity (pdf)		2019-10-07
CPT Crosswalk (xlsb)	Revised 05/19/2023	2023-05-19
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
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
MRR Tool – FY 22-23 (xlsx)	Revised 07/05/2022	2022-07-06
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 (pdf)	Revised 04/07/2023	2023-04-10
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 FY22-23 (docx)		2023-02-08
SOC Application - QIP Presentation (pdf)	Presented 10/22/19	2019-10-23
Service Code Approved Use Summaries -Appendix III (pdf)	Revised 09/26/2022	2022-10-05
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
Transferring Clients Between Different Program Sites (docx)	Revised 05/05/2023	2023-05-09
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 02/09/2023	2023-02-10
Authorization to Use or Disclose PHI (pdf)		2022-07-19
Authorization to Use or Disclose PHI - CHILD (dot)		2017-02-17
BHA – 0-5 FORMFILL (docx)	Revised 02/10/2023	2023-02-14
BHA – ADULT FORM FILL (doc)	Revised 02/10/2023	2023-02-14
BHA – CHILDREN FORM FILL (docx)	Revised 02/10/2023	2023-02-14
BHA – DEC FORM FILL (docx)	Revised 02/10/2023	2023-02-14
BHA – Explanation (docx)	Revised 07/27/2022	2022-07-28
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 SIGNATURE PAGE (docx)		2019-07-03
CONSENT FOR SERVICES (docx)	Revised 01/31/2023	2023-03-14
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
CSU EPISODE SUMMARY (docx)		2023-03-29
CSU EPISODE SUMMARY – EXPLANATION (docx)		2023-03-29
Case Management-Peer Support CP PN Form Fill (docx)	Revised 08/26/2022	2022-08-25
Case Management-Peer Support MHSA CP Explanation Sheet (docx)	Revised 05/03/2023	2023-05-04
Children’s Uniform Chart Order (docx)	Revised 02/09/2023	2023-02-10
Client Plan Explanation (docx)	Revised 10/07/2022	2022-10-10
Client Plan Form Fill (docx)	Revised 10/07/2022	2022-10-10
Consent for Services (docx)	Revised 01/31/2023	2023-02-08
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 09/22/2022	2023-02-17
DIAGNOSIS FORM (docx)		2018-02-13
DIAGNOSIS FORM EXPLANATION (docx)	Revised 05/26/2021	2021-05-26
DISCHARGE SUMMARY EXPLANATION (docx)	Revised 12/2022	2022-12-27
DISCHARGE SUMMARY FORMFILL (docx)	Revised 02/10/2023	2023-02-14
DISCHARGE SUMMARY PAPER FORM INSTRUCTIONS (doc)	Uploaded 07-05-2019	2019-07-05
Daily Progress Note (docx)		2023-01-05
Daily Progress Note Explanation Sheet (docx)		2023-01-05
ECBI EXPLANATION (docx)		2018-05-25
ESU NURSING NOTE FORM FILL (docx)		2020-08-17
Explanation for Eligibility Form (pdf)		2017-10-25
General Progress Note (docx)	Revised 08/26/2022	2022-08-25
General Progress Note Explanation Sheet (docx)	Revised 08/25/2022	2022-10-06
Group Progress Note (docx)		2023-01-05
Group Progress Note Explanation Sheet (docx)		2023-01-05
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
INFORMED CONSENT PSYCHOTROPIC MEDICATION ENGLISH (docx)		2021-03-05
INFORMED CONSENT PSYCHOTROPIC MEDS EXPLANATION (docx)		2023-05-23
INITIAL SCREENING FORMFILL (docx)	Revised 02/10/2023	2023-02-14
INITIAL SCREENING PAPER FORM INSTRUCTIONS (doc)	Revised 02/10/2023	2023-02-14
INITIAL SCREENING PERT FORMFILL (docx)	Revised 02/10/2023	2023-02-14
INITIAL SCREENING PERT PAPER FORM INSTRUCTIONS (docx)	Revised 02/10/2023	2023-02-14
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
MOBILE CRISIS ASSESSMENT (docx)		2023-05-30
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
PRIOR AUTHORIZATION DAY SERVICES REQUEST (docx)	Revised 04/01/2022	2022-03-25
PRIOR AUTHORIZATION DAY SERVICES REQUEST – EXPLANATION (docx)		2022-06-13
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
Problem List - FormFill (docx)	Revised 08/29/2022	2022-08-25
Problem List Explanation (docx)	Revised 08/26/2022	2022-08-25
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 Outside Facility ID Listing (xlsx)	Revised 03/2023	2023-03-30
Service Indicator Table Key (docx)		2020-03-18
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 07/01/2022	2022-06-21
UM Request Form (pdf)	Revised 07/01/2022	2023-05-08
VITALS FORM FILL (doc)		2017-03-02
WALK IN ASSESSMENT PROGRESS NOTE FORM FILL (doc)		2020-08-07
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

Arabic


MY_SAFETY_PLAN_FORM_FILL_ARABIC.docx		2018-01-19
INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_ARABIC.docx		2017-04-04
Authorization to Use of Disclose PHI - ARABIC (pdf)	Arabic	2017-02-17
CANS Family Letter - Arabic (pdf)		2019-04-10
CONSENT FOR SERVICES ARABIC (docx)	Revised 01/31/2023	2023-03-14
FINAL Coordination of Care Form-Arabic (pdf)		2016-07-13
PSC-Parent (Arabic)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (Arabic)_6_2018_interactive (pdf)		2020-03-25
YOUTH TRANSITION SELF EVALUATION ARABIC (doc)		2023-05-09

Chinese


CONSENT FOR SERVICES - Chinese (doc)		2023-03-14

Dari


CONSENT FOR SERVICES - Dari (doc)	Revised 01/31/2023	2023-03-14

Farsi


INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_FARSI.pdf		2017-09-14
INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_FORM_FILL_FARSI.docx		2017-09-14
MY_SAFETY_PLAN_FARSI.pdf		2017-09-14
MY_SAFETY_PLAN_FORM_FILL_FARSI.docx		2017-09-14
AUTHORIZATION TO USE OR DISCLOSE PHI FARSI (pdf)	Uploaded 07-23-2019	2019-07-23
CANS Family Letter - Farsi (pdf)		2019-04-10
CONSENT FOR SERVICES - FARSI (docx)	Revised 01/31/2023	2023-03-14
PSC-Parent (Farsi)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (Farsi)_6_2018_interactive (pdf)		2020-03-25
YOUTH TRANSITION SELF EVALUATION FARSI (doc)		2023-05-09

Korean


CONSENT FOR SERVICES - Korean (doc)	Revised 01/31/2023	2023-03-14

Somali


CONSENT FOR SERVICES - Somali (doc)	Revised 01/31/2023	2023-03-14

Spanish


AOA_PATIENT_MEDICATION_AGREEMENT_-_SPANISH.DOCX		2018-07-11
Authorization to Use or Disclose PHI - SPANISH (pdf)	Spanish	2017-02-17
CANS Family Letter - Spanish (pdf)		2019-04-10
CONSENT FOR SERVICES SPANISH (docx)	Revised 01/31/2023	2023-03-14
FINAL Coordination of Care Form-Spanish (pdf)		2016-07-13
INFORMED CONSENT PSYCHOTROPIC MEDICATIONS SPANISH (docx)		2021-03-05
MY SAFETY PLAN FORM FILL SPANISH (docx)	Revised 09/12/2019	2019-09-13
PSC- Parent Spanish 6 2018 Interactive (pdf)		2020-03-26
PSC- Youth Spanish 6 2018 Interactive (pdf)		2020-03-26
YOUTH TRANSITION SELF EVALUATION SPANISH (doc)		2018-05-25

Tagalog


INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_TAGALOG.docx		2017-04-04
MY_SAFETY_PLAN_FORM_FILL_TAGALOG.docx		2018-01-19
Authorization to Use or Disclose PHI - TAGALOG (pdf)	Tagalog	2017-02-17
CANS Family Letter - Tagalog (pdf)		2019-04-10
CONSENT FOR SERVICES - TAGALOG (docx)	Revised 01/31/2023	2023-03-14
FINAL Coordination of Care Form-Tagalog (pdf)		2016-07-13
PSC-Parent (TG)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (TG)_6_2018_interactive (pdf)		2020-03-25

Vietnamese


MY_SAFETY_PLAN_FORM_FILL_VIETNAMESE.docx		2018-01-19
YOUTH_TRANSITION_SELF_EVALUATION_VIETNAMESE.doc		2018-05-25
INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_VIETNAMESE.docx		2017-04-04
Authorization to Use or Disclose PHI - VIETNAMESE (pdf)	Vietnamese	2017-02-17
CANS Family Letter - Vietnamese (pdf)		2019-04-10
CONSENT FOR SERVICES - Vietnamese (docx)	Revised 1/31/2023	2023-03-14
FINAL Coordination of Care Form-Viet (pdf)		2016-07-13
PSC-Parent (VI)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (VI)_6_2018_interactive (pdf)		2020-03-25

UTTM


QM...Up to the Minute - May 2023 (pdf)	2022 - 2023	2023-05-12
QM...Up to the Minute - April 2023 (pdf)	2023	2023-04-14
QM...Up to the Minute - March 2023 (pdf)	2023	2023-03-14
QM...Up to the Minute - February 2023 (pdf)	2023	2023-02-10
QM...Up to the Minute - January 2023 (pdf)	2023	2023-01-13
QM...Up to the Minute -December 2022 (pdf)	2022	2022-12-13
QM...Up to the Minute -November 2022 (pdf)	2022	2022-11-14
QM...Up to the Minute - October 2022 (pdf)	2022	2022-10-18
QM...Up to the Minute - September 2022 (pdf)	2022	2022-10-18
QI...Up to the Minute - FY 2021 -2022 (pdf)	2021 - 2022	2022-09-20
QM...Up to the Minute - August 2022 (pdf	2022	2022-08-12
QM...Up to the Minute - July 2022 (pdf)	2022	2022-07-20
QM...Up to the Minute - June 2022 (pdf)	2022	2022-06-10
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

CCBH Training page - Tips and Resources

Training Classes Video Tutorials and Resource Packets

Admin Data Entry

Service Entry Training

Scheduler Orientation and Practice Exercises

Assessments Orientation and Practice Exercises

Crisis House Assessments Orientation and Practice Exercises

Client Plans and Progress Notes Orientation and Practice Exercises

Progress Notes Orientation and Practice Exercises

Doctor's Homepage Orientation and Practice Exercises

View Only Assessments

TBS Client Plans and Progress Notes Orientation and Practice Exercises

CCBH Login Process Tutorial

Admin Data Entry Resource Packet (pdf)

Service Entry Resource Packet (pdf)

Scheduler Resource Packet (pdf)

Assessments Resource Packet (pdf)

Crisis House Assessments Resource Packet (pdf)

Progress Notes Resource Packet (pdf)

DHP Resource Packet (pdf)

View Only Resource Packet (pdf)

Progress Note Correction Resources

Progress Notes Correction Video Tutorials

Billing Correction Tutorials

Other Training Resources and Tip SheetS

Reports Demonstration

CCBH Reports Manual (pdf )

Access to Services Journal Video Tutorial

Covid-19 Dashboard Tutorial available online (new)
Claim It Anyway (CIA) Webinar available online (new)
Access to Services Journal Video Tutorial available online.
NOABD Webinar available online
Service Indicators Webinar available online

New Program Manager Orientation Presentation (pptx)

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 (pdf)	Updated 04/01/2023	2023-04-21
Progress Report to Child Welfare Services Form Fill (pdf)	Revised 04/01/2023	2023-04-21

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 03/24/2022	2022-06-03
AB1299 STRTP Admission Report Explanation Form (pdf)	Revised 03/24/2022	2022-06-03
BHS Contractor Memo – Tracking Out of County Medi-Cal Beneficiaries in CCBH – Revised AB1299 STRTP Admission Report (pdf)	Memo Date 03/04/2022	2022-06-03
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
Daily Progress Note (docx)		2023-01-05
Daily Progress Note Explanation Sheet (docx)		2023-01-05
Optional AB1299 STRTP Tracking Tool (xlsx)	Revised 03/02/2021	2021-03-02
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)		2022-06-10
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 UM Request Form (docx)	Revised 11/01/2022	2022-11-17
STRTP Utilization Management Request Explanation Form (pdf)	Revised 11/01/2022	2022-11-17
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
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)	Revised 03/01/2023	2023-03-03
TFC DAILY PROGRESS NOTE FORMFILL (doc)	Revised 03/01/2023	2023-03-03
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 06/01/2023	2023-06-01
San Diego Certified Peer Support Specialists – BILLING CODES (pdf)	Revised 05/30/2023	2023-05-30
San Diego Certified Peer Support Specialist – TRAINING REQUIRMENTS (docx)		2023-05-25
2023-05-17-BHS Memo-Update on Peer Support Services Implementation (pdf)		2023-05-25
Scholarship Flyer Peer Support Specialist Certification Program (pdf)		2022-10-18
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

Financial Eligibility and Billing Manual (pdf)

Billing Unit Resources

Billing Unit Forms

CalAIM


BHS Contractor Memo-CalAIM Documentation Reform (pdf)	05/22/2022	2022-05-24
DHCS CalAIM Behavioral Health FAQ (pdf)		2023-01-03

TBS


BHA - TBS EXPLANATION (docx)	Revised 02/02/2022	2022-02-04
BHA TBS Form Fill (doc)	Revised 02/02/2022	2022-02-07
Brochure - English & Spanish 2.2023
TBS CLIENT PLAN FORM FILL (docx)		2018-05-25
TBS CLIENT PLAN SIGNATURE PAGE (docx)		2018-05-25
TBS One Pager for Providers (pdf)		2023-02-15
TBS Overview PPT (pdf)		2023-02-15
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

Cerner Millennium


Cerner Millennium Introduction Meeting Presentation (pdf)	Presented 05/16/2023	2023-05-17