LifeWays Provider Manual

Fiscal Year 2010-2011 (October 1, 2010 - September 30, 2011)

The LifeWays Provider Manual is included in the contract between LifeWays and service providers in the areas that are applicable to their service delivery. 

The Provider Manual outlines expected standards of care. 

The information herein is subject to change at any time by LifeWays action.  Changes will be communicated to service providers immediately via email by a member of the LifeWays Network Performance Team. 

LifeWays will make every effort to keep changes to a minimum to avoid unnecessary burden for providers.  The intent is to publish quarterly updates throughout the course of the fiscal year. 

The Provider Manual is offered in Adobe (pdf) format and you will need Adobe Reader to open and view.

A brief description of the section is provided below.  You may search for key words after opening the PDF document using the Adobe Find tool.  Files have been compressed but still may take time to download on your computer.

Section 1 Includes: LifeWays overview, organizational chart, telephone numbers, description of what is a PIHP and CMHSP, glossary of terms and acronyms.

730 KB, 42 Pages

Section 2 Includes: Credentialing process/information to become or maintain membership on the LifeWays Provider Network, staff provider qualifications, ethical standards, procurement procedure, corrective action to suspend or limit credentialing status, contract distribution process, new provider orientation, network capacity evaluation, provider training requirements, provider network monitoring

766 KB, 82 Pages

Section 3 Includes: Procedures, standards, and expectations of care to protect and uphold the rights of persons served, critical incident reporting, death reporting, investigation of a complaint, recipient rights advisors, advisory committee, training

908 KB, 94 Pages

Section 4 Includes: Process for accessing services depending of access point, provider responsibility for crisis intervention and afterhours support, waiting list for accessing CMH services, Medicaid verification, medical necessity critieria for CMH services, service descriptions, program descriptions, services available by funding source or benefit plan, UM criteria for service authorization, process for authorization request, Level of Care parameters for assessing need, UM Team assignments by service type, clinical case review procedure and tool

1.6 MB, 135 Pages

Section 5 Includes: Advanced directives, care coordination, clinical record review policy and tools for provider use, consumer demographic reporting requirements and forms, environment of care standards for residential settings, HIPAA, MIMBPIS-performance indicators issued by MDCH, timeliness monitoring and reporting, model payment system (MPS), petition for outpatient treatment orders, criminal background check requirement in residential settings, standards and best practice guidelines, standardized clinical forms policy, records storage and retention, consumer health conditions and proxy measure reporting instructions

4.3 MB, 243 Pages

Section 6 Includes: Behavior Risk Management Committee (BRMC) procedure and behavior treatment plan practice guideline and forms, recovery model, self-determination, practice guidelines and medication algorithms by diagnosis/disorder, service model fidelity assessments, special treatment procedures, MDCH practice guidelines

1.9 MB, 120 Pages

Section 7 Includes: Claims submission procedure for payment by LifeWays, clean claim policy, payment schedule, acceptable codes and modifiers, MDCH resource documents describing codes and staff qualifications, ability-to-pay/fee determination procedure and forms, family support subsidy program procedure and forms

4.6 MB, 95 Pages

Section 8 Includes: Medical guidelines and best practices, drug formulary (Medicaid and non-Medicaid), medication payment assistance, lab payment assistance, service referrals, crisis protocols, recommended med monitoring parameters, integrated health nursing assessments and forms, case closing procedure, Clozaril and injections, on-call RN, physicians committee, performance review, scheduling, reassignment per consumer request, medical records management and forms

967 KB, 111 Pages

Section 9 Includes: Advisory council appointment, medical records release of information, support groups, planning for persons with limited English proficiency, provider access to closed records, transfer of consumer records, use of LifeWays meeting rooms and reservations, grievance and appeals procedure and forms

432 KB, 53 Pages