Provider FAQ

Print
Press Enter to show all options, press Tab go to next option

Welcome to Fresno County Mental Health Plan’s (FCMHP) Frequently Asked Questions. Here you will find answers to the most often asked questions. These questions fall in nine categories. Please contact us if you need additional clarification.

If you do not find your question on the list please e-mail us and we will be happy to research it for you.


Assessment

Can I schedule a two-hour block to do the assessment?

Yes. You may schedule your assessment either in a two-hour block of time or, (if more convenient to your needs and those of your client) in two sessions of one hour each.

If it takes two separate sessions to complete an Assessment, can I submit the complete assessment and treatment plan at one time?

Yes. Although your assessment may require two visits, on two different days, you are only required to submit one completed Assessment form. The treatment plan is the last page of your assessment and must be submitted with your completed Assessment.

Is the client’s signature required on both the Assessment and treatment plan forms?

No. The client’s signature is required only on the treatment plan, however the clinician is required to sign and date both the Assessment, and the treatment plan.


Treatment Plan

Does the client’s treatment plan have to be completed on the date that you saw the consumer?

No, but it must be completed, submitted, and services authorized before billable services may be rendered.

What date should be on the treatment plan?

Clinician should date when plan is completed.

If I receive a feedback letter due to a missing signature, do I submit a new treatment plan or return the same one with my signature?

No, obtain the client’s signature on the next visit and keep the record on file. The MHP will review this document during the audit.

For situations that change, is a new treatment plan required?

Yes. Changes in requests for services or for additional services require an amended authorization and modification of your existing treatment plan.

What kinds of documentation denote how the client is doing?

Ideally, the treatment plan you develop for the client will detail specific, observable, or measurable mental health symptoms or behaviors which are problems for the client. The objectives stated will also be specific, observable, measurable changes in those identified symptoms/behaviors. Change or lack of change in those symptoms/behaviors will be an indicator of how the child is progressing, and must be documented on the progress notes.


Progress Notes

Should individual types of services be included on the progress notes with family services?

The notes should address the service being billed. For example, if you bill for a family session the notes should reflect a family session.

Do I have to submit notes for each member of the family?

No, you only need to submit notes for the Medi-Cal beneficiary you are authorized to treat.

If I have a request to work with a divorce case where they want marriage counseling and also see the family, say we’re seeing two of the kids and we want to see them individually, what do we put in the progress notes?

Marriage counseling is not covered by Medi-Cal. If you have been authorized to see one of the parents for an identified Medi-Cal included mental health diagnosis and are billing the family sessions under that parent’s name, you will not be able to work individually with the children under that parent’s name. You will need to check the Medi-Cal eligibility of the two children and request services for each individually.


Authorizations

What types of services require an authorization?

Pre-authorization of services is only required for Therapeutic Behavioral Services, Psychological/Neuropsychological testing, and for minors who are court dependents of other counties placed in foster care or group homes in Fresno County. Outpatient Specialty Mental Health services do not require pre-authorization. 

How do I request a Service Authorization Request (SAR) for a minor who is a court dependent of another county (placed in foster care or group homes in Fresno County)?

When checking a minor's Medi-Cal eligibility, you may occasionally discover that they have Medi-Cal eligibility from another county. If these minors are court dependents of another county who are placed in foster care or group homes in Fresno County, you must contact the SAR Coordinator at (559) 600-4645 as soon as possible to acquire the appropriate authorization to treat the minor beneficiaries. See your Provider Manual for more information, specifically the section "Services Requiring Authorization".

Can I bill for different service(s) than those I already have authorized?

You may, however you will only be paid for services that have been pre-authorized.

How long does it take for an authorization for Psychological testing?

The MHP has a total of 14 calendar days to process ALL authorization requests, although most are processed within 5-7 days. However, if the request is pending due to a need for additional information or clarification, then the provider has a total of 30 days to provide the additional information. If a request for Psychological testing is approved, like other approved service(s), an authorization will be sent to the provider. The actual appointment will depend on provider availability.

What is considered the receipt date of an authorization, the date faxed or the date reviewed?

If a request for authorization is faxed or sent by encrypted e-mail, the fax date is considered the date received. If a request for authorization is mailed, the date received at the Managed Care office is considered the receipt date.

If I sent in an authorization but it can’t be found, will that authorization still be honored?

All authorization requests are logged so any request that is logged will be honored. However, if we have no record that it was received/logged, then you must submit another copy showing the original fax date. If the request was logged, but we cannot find the paperwork, we will honor the log date, and ask that you submit another copy.

Can I schedule an appointment beyond the assessment with the client prior to receiving an authorization?

You can, but at your own risk of not being paid. Claims for services that are provided prior to the authorization begin date will usually be denied.

If six members in one family are seen, is a separate form required for each member?

As the clinician, you must decide who is/are the primary client(s). If you wish to provide individual or group sessions, you must complete an Assessment for each individual for whom you wish to provide those services. If you wish to include family members in the primary client’s treatment, you would not need to complete an Assessment for those individuals.


Consent For Treatment & Confidentiality

Am I required to use the MHP’s consent form?

No, although a signed Consent for Treatment is a required documentation in the consumer’s chart, the MHP’s consent form is provided to you only as an example of items and wording that you may want to include in the form you use or develop.

Can foster parents sign the Consent form?

Caution is advised in foster parent situations because it depends upon whether the child has been placed with foster parents (a) by court order or with the consent of the legal guardian, or (b) on a temporary basis before a detention hearing has been held. If the court orders placement of a child with foster parents, and mental health assessment and/or treatment, the foster parent may sign the consent for treatment form. Written evidence of the foster parent’s authority (e.g., copy of court order documents or the consent of the child’s parent or legal guardian) should be placed in the chart. Foster parents with temporary custody before detention hearing and court ordered placement do not have authority to consent to treatment.

Does the authority to consent to treatment include foster families and agencies that work with CPS and CASA cases?

See previous question.

Am I required to report physical violence if the child informs me that this is happening?

California Penal Code sections 11164 through 11174.3 require a “child care custodian” or “health practitioner” who has knowledge of or reasonably suspects a child has been a victim of abuse, to report such instances of child abuse to a child protective agency immediately or as soon as possible by telephone, and by written report within 36 hours. A “child care custodian” includes, among others: social workers, teachers, teacher’s aides, licensed day care workers, probation officers, parole officers, family support officers. A “health practitioner” includes, among others: physician, psychiatrist, psychologist, marriage and family therapist, and clinical social worker.

Does the MHP want the signed consent for treatment form?

The signed consent for treatment form should be filed in the consumer’s chart, and Managed Care staff will verify this during audits. The consent for treatment form should be signed by the parent, legal guardian, or other person authorized to give consent. A social worker or probation officer may consent to treatment if so ordered by the court. Request written evidence of that authority.

For minors, do we use the guardian, parent or foster parent for the signature on consent for treatment and does it need to be an original signature?

The parent should sign the treatment consent, unless the child is in the legal custody of someone else, and that person has been given authority to consent to treatment. Again, ask for written evidence appointing legal guardian, foster parent, or other with authority to consent to treatment. Place copies in the consumer’s chart. The original signature on the consent for treatment form should be filed in the consumer’s chart.


Provider Relations, Billing & Claims

What is the process for an appeal of a denied claim?

Providers may appeal a dispute with the FCMHP regarding the processing or payment of a provider's claim to the FCMHP. Please refer to Section 6.0.2.1 of your Provider Manual for more information.

For an assessment, bonding study or psychodynamic test, should Box 21 (diagnosis) be completed?

Yes, Box 21, the diagnosis, must always be completed for any service provided.

On the HCFA 1500 form do I have to bill the amount that is on the MHP fee schedule?

No, but you should bill at least the amount on the MHP fee schedule. The MHP will pay the lesser of the billed amount or the fee schedule amount.

What is the purpose of Box 24E (diagnosis code)?

This is to identify the primary authorized diagnosis and this is the diagnosis code that is submitted to the Medi-Cal program.

What is the billing process when there is a third party insurance involved?

You need to obtain the billing information from the consumer and then bill the other coverage first. They have 60 days to issue payment or denial. After receiving a denial or partial payment the provider has 30 calendar days from the date of denial/Explanation of Benefits (EOB) to bill Managed Care. Please contact your Provider Relation Specialist.

What does the “F” mean after the service code?

This is a suffix identifier unique for Fresno County codes.

Where do I find the authorization number to put in Box 23?

This number is on the approved authorization that you receive after submitting a request. The authorization number must be submitted on all claims for services requiring authorization.

Where do I get the Eligibility Verification Confirmation (EVC) number?

Section 4 of your Provider Manual will explain how to access AEVS to perform eligibility verification where you will be issued an EVC number or you may access the Medi-Cal website at https://www.medi-cal.ca.gov/Eligibility/Login.asp

If the consumer is a Fresno County beneficiary and is later switched to another County, will I be paid for those services after the county is changed?

No, it is the provider’s responsibility to verify the consumer’s eligibility prior to delivering services to the consumer.

Can I bill an assessment provided to a physically disabled consumer?

Yes, provided that you are assessing for an included mental health diagnosis.

Can I bill an assessment for a severely retarded client if he/she has some other included diagnosis, i.e., depression?

Yes, provided that you are assessing for an included mental health diagnosis.

Can I bill for “no shows”?

No, please see section 4.3 in your provider manual.

If there are two or more diagnosis codes, does the diagnosis always go in Box 21?

Yes, you always need to enter the primary authorized diagnosis in Box 21, line 1; any other diagnosis(es) should be listed in appropriate order.

How is the claim completed if a two-hour assessment is completed in two different one-hour sessions?

Both sessions should be entered as separate entries, showing each date of service in Box 24.

Will the claims submission period ever be extended from 30 days to 60 days?

Not at this time, however, we may re-evaluate this policy in the future.

If I am providing only an assessment and no further treatment for a client, can I send in a HCFA form without a diagnosis or can I use a rule out diagnosis?

You need to use an included mental health diagnosis. A rule-out diagnosis is acceptable as long as it is an included mental health diagnosis.


Supported Employment and Education Services

Do you cultivate jobs out in the community for mental health consumers?

Supported Employment and Education Services provides supported employment that is paid work in a normal, integrated work setting. Staff engage in job development and support consumers with follow-along services once they are on the job to assure they are able to overcome problems which may affect their productivity and effectiveness. Work evaluation and work adjustment activities are also components of the program. Supportive education services are provided for adults returning to school or who are already seeking their GED, taking community college, state college or adult education classes.


Miscellaneous

Do I have to use the MHP forms?

Yes. Effective 7/1/00, providers must use the forms developed by the MHP. These forms include information required by the State Medi-Cal program.

Is there a list of all included diagnoses?

Yes, see Section 4 in your provider manual.

What can be done to stop the foster parent(s) from missing scheduled appointments? Are there any consequences for them?

Notify the CPS worker who will intervene on the child’s behalf.

Can I refuse to see a consumer if the parent or foster parent has missed many consecutive appointments and hasn’t called?

Yes. Caregiver should be made aware of your policy in advance.

Can you briefly explain the Cal-Works program?

Cal-Works is California’s version of Welfare to Work. TANF (formerly AFDC) recipients are assigned to a Job Specialist who works with them to help overcome the barriers to employment in their lives. Mental Health’s part in this is called the Employment Services Program (ESP). Job Specialists have a mental health-screening tool, which they administer to their clients. If mental health problems are suggested by the results of the screening tool, the client is sent to ESP for an assessment by a mental health clinician. If the client has a mental health problem sufficiently serious to meet Medi-Cal’s medical necessity criteria, the client will receive services from the ESP staff and may also be referred to a contract provider for individual/group therapy or medication evaluation (currently through Fresno County Mental Health Adult Outpatient Services). Those clients who do not meet medical necessity are still eligible to receive non-Medi-Cal billable services from the ESP staff which may include groups and case management services. The ESP staff have gone through an orientation with the Job Specialists and assist the clients in understanding and meeting Cal-Works expectations.

Do I indicate if the client is Cal-Works? If so, where?

Yes. You must document if a client is referred by Cal-Works as this is a CSI reporting requirement. There is a space to document this information on the Assessment and Reauthorization forms.

How do I change a diagnosis after the assessment?

Note the change in diagnosis in your Progress Notes and attach a copy of that note with your claim. In addition, add change in diagnosis in current assessment or reauthorization request with date and initials so change is clear at the time of audit.

Do I need to provide a number and description of the DSM code on the assessment or reauthorization request?

Yes

What do I need to do and what is required to discharge a client?

Complete a discharge summary and send it in to the Managed Care office as soon as it is clear that you will not be continuing services with the client.

What is the Crisis Stabilization Center? Where is it located? Is it part of Fresno County?

The Crisis Stabilization Center provides assessment, crisis intervention, and crisis stabilization services 24 hours a day, 7 days a week. It is no longer operated directly by the County of Fresno. The Crisis Stabilization Center is operated by a contracted organizational provider. It is located at 4411 East Kings Canyon Rd, Fresno, CA 93702.


Youth Link/Court Referred Cases

Where is Youth Link (YL) indicated on the assessment form?

On page l of the MHP Clinical Assessment form, there is a check-off area denoting if a client is seen under the Youth Link classification. The wording is as follows: “Youth-Link: Yes __ No __”.

Whom do I contact when pertinent information is not provided by YL?

It is essential that the provider and CPS worker communicate directly in matters related to the requested services. Secondly, YL can assist in any clinically related questions. Managed Care will pursue any authorization or payment inquiries.

Do I contact the CPS worker regarding court ordered clients?

Yes, please see the prior question.

Can I bill for mental health services that are not on the court order to Medi-Cal?

A Medi-Cal consumer can receive any Mental Health (MH) service(s) deemed medically necessary over and above what is court ordered. Your justification for such services will be reviewed by Managed Care and authorized or denied as appropriate.

Can the caseworker and number be clearly stated on the referrals?

The case number is clearly printed on the referral letter. The Case Worker name, if unclear, can be obtained by calling CPS and referencing the case number.

If family therapy or case management is provided, is it billed under the child’s name?

Yes, we would like as many MH services billed under the identified child in treatment. If there is more than one case open per family, please ask for the above sessions under each identified client's name.

If I received a court order for a parent and child asking for assessment, do I open two cases?

If the child and the parent are court ordered to receive a MH assessment, you would open two records, both billed and reported separately.

Can I begin the assessment without all the necessary documents?

You should not begin an assessment without the referral letter from YL. The accompanying documents advise you whom to see and for what purpose. You want to be clear on what issues need to be addressed as related to the court process. If urgent, this direction can be obtained without all the necessary documentation. You will not get paid for services that were not indicated.

Will all the necessary information be provided in the court order?

The information should be considered preliminary. Collaboration with the CPS Case Worker, or his/her supervisor is advised prior to your contact with the client.

Why are Department of Mental Health (DMH) numbers not always provided?

DMH #’s are available only for those consumers who currently have or have had previous involvement in Fresno County’s mental health system.

What is the difference between the DMH and CPS number?

These are two separate record keeping systems for the Department of Mental Health (DMH) and the Department of Social Services (CPS).

If I receive an assessment and I am not sure if it is a YL consumer and all I have is the letter what should I do?

Please call YL to verify the consumer’s status.

Do I contact Managed Care before contacting the consumer?

No, once you receive the referral as the assigned provider, you are in charge of scheduling with the consumer. CPS can assist as needed.

Why am I having a problem coordinating with the CPS workers to leave detailed messages?

If there is a problem with return calls from a CPS worker please contact their supervisor listed on the back of the 6169 form. Voice messages should be detailed enough to provide information required.

What is Youth Link’s address?

3133 North Millbrook, Fresno, CA 93703.

On court ordered counseling, after the assessment, what do I have to submit and how long do I have to submit it in writing. How detailed do I have to be in determining the need for continuing counseling?

It is imperative that you communicate with CPS regarding required information, timelines, and issues needing to be addressed. Requests for authorization for continued services for Medi-Cal clients should be sent to Managed Care. Submit the assessment and treatment plan to Managed Care for authorization.

What paperwork does CPS need on court ordered cases?

This is determined by the CPS caseworker and review of the court order. All cases may differ depending on the issues needing to be addressed. Typically, a Quarterly Report to the court is required.

If I get a court-ordered case and the client has been in therapy for a few years, and after a few sessions I find that he/she does not need any further therapy, what do I do and what information must I provide?

In your clinical evaluation you may determine treatment is no longer medically necessary and discharge is appropriate. Please submit a discharge summary to Managed Care and any final documentation CPS may need.

If a child has informed me that his/her parents are neglectful or abusive, who do I contact? Is there a form that must be completed?

As a mandated reporter you are required to contact the CPS to report this type of information and proceed accordingly. Please use the Suspected Child Abuse Reporting Form.

Please explain the bonding study. Do I also provide a "psych" test on these clients?

Bonding studies answer specific questions posed by the court on each case regarding the quality of attachment between the child and parent. Some psychological testing has been used to determine the mental health functioning of a particular parent, but is not always required.

What is the RDS date and why is it important?

Review of Dependency Status (RDS) is held every six months by the court to determine adherence to court orders. This could result in a significant decision impacting parent rights and/or the permanent plan for the minor(s).

What are the consequences for not submitting the court report on time?

This delays the court process and may adversely impact the parental right to custody of the child. Sanctions may be imposed, such as contempt of court, subpoenas, etc.

How much time do I have on getting started with the client, or returning the referrals to YL, if needed?

You are allowed two weeks to schedule a client for an initial assessment. Please contact CPS for direction if you cannot meet this timeline. If you decide to return the referral to YL, they need to know what has been done and if the case requires reassignment.

In some instances I find out that the child is in a foster care environment and I didn’t know about this prior to making the appointment call. How do I get more information from YL other than social security, DOB, and a phone number to prevent situations like this from occurring?

You may decide to contact CPS for additional information on a case prior to your initial client call. CPS can assist you in gathering any additional information, contacting the client, or providing transportation as needed.

Can a YL client have an excluded diagnosis and still get authorized services?

YL clients cannot receive a primary excluded diagnosis and be reimbursed by mental health Medi-Cal. If you do not find medical necessity for mental health treatment, you may be authorized for services to continue to address CPS/Dependency Court issues by Youth Link.

What is a realistic time frame to allow parents to get back on track before returning information to court?

Use the Review of Dependency Status (RDS) hearing date as a reference point. The dependency court is inclined to reunify the family in light of the best interest of the child. The outcome must be determined within the timelines set forth by law. On-going collaboration with the court via CPS would allow continuous communication of your concerns.