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PROVIDER MANUAL AND ALERTS
IMPORTANT CONTACTS
IVR AND EXTENSION SCREENS
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REPORTS AND SUPPORT MATERIALS
INFORMATION FOR PCCs
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QUALITY MANAGEMENT
RAPID ADMISSION INCENTIVE



Information for Primary Care Clinicians

The Primary Care Clinician (PCC) Plan Performance Improvement Management Services (PIMS) program is a comprehensive, clinically-focused management program that measures, monitors and improves the delivery of health care to PCC Plan Members. To support these objectives, PIMS provides PCCs with reports and information about services for members.

Performance Improvement Management Services assist PCCs by:
  • Providing a PCC Profile Report to PCCs who serve more than 180 PCC Plan members. This report tracks PCCs performance across several clinical areas, and provides data to allow the PCC to compare performance to other PCCs and to selected benchmarks.

  • Mailing a Reminder Report (RR) and a Care Monitoring Report (CMR) to all PCC Plan PCCs. These reports contain comprehensive lists of members who are overdue for preventive care.

  • Reviewing these performance-based reports every six months through face-to-face visits with PCCs who serve more than 180 PCC Plan Members. PIMS Regional Network Managers (RNMs) work collaboratively with PCCs to develop quality improvement goals suggested by the reports.

  • Conducting regionally-focused quality forums in clinical and administrative areas. These forums focus on improving the delivery of health care to PCC Plan Members.

  • Making available information and referral activities through the PCC Hotline, which is available to all PCC Plan PCCs regardless of their PCC Plan Member panel size.

  • Developing and distributing publications including a provider newsletter and a support materials catalogue.



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Link SymbolThird Party Liability (TPL) FAQs
 Click here for Frequently Asked Questions about MBHP's Provider Alert #126 regarding Third Party Liability.

Link SymbolExpedited Authorization Website
 An Expedited Authorization and Mental Status Update website is available for all eligible Emergency Service Program providers starting June 1, 2012: please click here to connect.

Link SymbolMBHP has gone Green!
 Notices of new routine authorizations, and the letters themselves, are available at the MBHP/ValueOptions online provider portal ProviderConnect. Letters related to adverse actions or denials continue to be sent through the mail. To hear a previously presented training on the authorization letter Go Green program click here.

Link SymbolChildren's Behavioral Health Initiative (CBHI)
 Please click here for information, including performance specifications, for Children's Behavioral Health Initiative (CBHI) services.

Link SymbolFile Electronic Claims
 Learn more about the advantages of submitting electronic claims.

Link SymbolRights for Your Members
 Information on rights, appeals, and grievances for your Members

Link SymbolContact MBHP
 We're here to answer your questions and address your concerns.

Link SymbolMassHealth Provider Services Department
 1-800-841-2900
Primary Care referral sources, community resources, and acute and Urgent Care Services Facilities

 

 

 

MBHP - Massachusetts Behavioral Health Partnership
1000 Washington Street, Suite 310, Boston, MA 02118-5002 : 1-800-495-0086
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This page was last updated: 2/8/2010