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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

NOABD

NOABD Webinar available online.

Please go to the new MH & DMC-ODS page’s NOABD tab to access files. This tab is in the process of being sunset.

Beneficiary

Please go to the new MH & DMC-ODS page’s Beneficiary tab to access files. This tab is in the process of being sunset.

Communications
2024-09-03 BHS Info Notice - Outcome Measures for Children & Youth (pdf)
2024-09-04
2023-12-28 BHS Info Notice - SMHS Documentation Reform (pdf)
2024-01-04
2023-09-12 - BHS Contractor Memo #2 TAY CANS (docx)
2023-09-14
2023-06-29-BHS Contractor Memo-Single Point of Access for ACT and SBCM (pdf)
2023-08-02
2023-05-20-BHS Provider Memo-Payment Reform CPT for SMHS (pdf)
2023-06-06
BHS Contractor Memo – CalAIM Documentation Reform (docx)
08/15/2022 2022-08-25
BHS Contractor Memo-CalAIM Documentation Reform
05/22/2022 2022-05-24
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
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
CYF MEMO - Revised CANS Sharing Confirmation 3.26.19 (pdf)
2019-04-09
QM MEMO - Privacy - Confidentiality Legislative Updates 10.23.18 (docx)
2018-10-24
QI_PIT_MEMO_2018 6-1-18 AOA Substance Use Tracking Reporting Changes (pdf)
2018-06-14
QM_MEMO_-_New_Auth_to_Use-Disclose_Multiple_Form_051513.pdf
2017-05-12
QM Memo - New Billing Indicators - Intrepreter and Language 06-08-17 (pdf)
2017-06-14
QM Memo - Holder of Records 01 03 13 (pdf)
2016-07-15

Forms
5150 Form (pdf)
Revised 09/2023 2023-11-09
CAPS Administrative Days Weekly Contacts Log (docx)
2024-07-22
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
MAA Service Record (pdf)
2017-08-24
Medi-Cal Administrative Activities (MAA) Procedures
2017-08-24
Reestablishment Recommendation Form (doc)
2021-03-12
Request for Verification of Veterans Eligibility (pdf)
2017-03-23
START TCC and URC Record (pdf)
2017-03-23
START URC Minutes Form (pdf)
2017-03-23
Service Authorization Request (pdf)
2021-03-12

Manuals

Please go to the new MH & DMC-ODS page’s Manuals tab to access files.  This tab is in the process of being sunset.

OPOH

Please go to the new MH & DMC-ODS page’s OPOH/SUDPOH tab to access files. This tab is in the process of being sunset.

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
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
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
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
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)
Revised 06/26/2023 2023-06-27
Billing SMHS for Sibling Sets Guidelines (docx)
2024-05-09
Billing for Medication Services (docx)
11/29/2023 2023-12-04
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
Denial Report Instructions (ppt)
2019-09-16
Diagnosis Practice Guidelines (pdf)
Updated 01/24/2022 2022-01-25
FY 24-25 FWA Reference Document (pdf)
2024-10-15
FY 24-25 Reason for Recoupment SMHS Final (pdf)
Revised 09/27/2024 2024-10-15
HOW Service Model Data Collection Flow (pdf)
2021-03-12
Housing Quality Checklist (docx)
2023-07-11
Interactive Add-On for Admin Staff (pdf)
2023-07-11
Interactive Add-On for Clinical Staff (pdf)
2023-07-11
Interpreter Add-On for Admin Staff (pdf)
2023-07-11
Interpreter Add-On for Clinical Staff (pdf)
2023-07-11
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)
2024-11-07
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
Mental Health Professional Licensure Waiver (pdf)
2021-01-06
Mobile Crisis Billing Tip Sheet (docx)
2024-08-07
Mobile Crisis Response Documentation Requirements (docx)
2024-08-07
New Contractor Orientation Resources (pdf)
Revised 04/02/2024 2024-07-10
Progress Note Checklist Table (pdf)
Checklist 2020-03-10
QAPR Program Compliance Attestation - FY 24-25 (docx)
Revised 09/23/2024 2024-09-26
QAPR Tool – FY 24-25 (xlsx)
Revised 09/23/2024 2024-09-26
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
SOC Application - QIP Presentation (pdf)
Presented 10/22/19 2019-10-23
San Diego County BHS Abbreviations List (pdf)
Revised 03/23/2022 2023-07-31
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)
Revised 08/22/2023 2023-09-01
Transferring Clients Between Different Program Sites rev. 12.28.23 (docx)
2024-01-04
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
A/OA Outpatient Utilization Management Form
2019-02-08
A/OA Outpatient Utilization Management Form Explanation Sheet
Revised 01/31/2019 2019-02-08
A/OA Patient Medication Agreement Explanation Sheet
2018-07-26
Advanced Directive Explanation Sheet
2018-05-25
Advanced Directive Advisement
2018-05-25
Ancillary SMHS Request Form
2020-01-10
Ancillary SMHS Request Form Explanation Sheet
2020-01-10
Authorization for the Disclosure of Protected Health Information (pdf)
2024-10-01
CSI Standalone Collection
2024-09-11
CSSRS- Adult LT
2024-09-11
CSSRS- Child LT
2024-09-11
CalAIM ASSESSMENT EXPLANATION SHEET INSTRUCTIONS (docx)
Revised 12/05/2024 2024-12-12
Care Plan Explanation Sheet (docx)
Revised 11/01/2024 2024-11-01
Child/ Youth Utilization Management Request Form
Revised 09/03/24 2024-09-04
Child/ Youth Utilization Management Request Form Explanation Sheet
Revised 09/03/24 2024-09-04
Client Clinical Problems
2024-09-11
Client Face Sheet
09/2024 2024-09-11
Coordinated Care Consent (docx)
Revised 12/09/2024 2024-12-11
Coordinated Care Consent Explanation Sheet (pdf)
2024-12-13
Coordination with PCP & BHS Explanation Sheet
2024-09-05
Coordination with Primary Care Physician & Behavioral Health Services
2024-09-05
Daily Progress Note_Final 2.6.25 (docx)
2025-02-10
Day Treatment Service Note (Shift Summary)
2024-09-11
Diagnosis Document
2024-09-11
Discharge Summary
2024-09-11
Eyberg Child Behavior Inventory (ECBI) Explanation Sheet
2018-05-25
Full Service Partnership (FSP) Agreement
07/30/24 2024-09-11
IOP & PHP Prior Authorization - Day Services Request Form (DSR)
Revised 01/02/2024 2024-01-04
IOP & PHP Prior Authorization - Day Services Request Form (DSR) Explanation Sheet
2024-01-04
Illness Management & Recovery (IMR) Adult Explanation Sheet
2018-02-13
Illness Management & Recovery (IMR) Assessment
2021-02-02
Informed Consent for Taking Psychotropic Medications Explanation Sheet
2023-05-23
Informed Consent for Taking Psychotropic Medications Form
2021-03-05
Intensive Home-Based Services (IHBS) Prior Authorization Explanation Sheet
Revised 02/01/2024 2024-02-19
Intensive Home-Based Services (IHBS) Prior Authorization Request Electronic Form Instructions
Revised 02/07/2024 2024-02-12
Intensive Home-Based Services (IHBS) Prior Authorization Request Form
Revised 02/01/2024 2024-02-12
Level of Care Utilization (LOCUS) Adult
Adult Version 20, December 2016 2019-06-28
Level of Care Utilization (LOCUS) Adult Explanation Sheet
2018-02-13
Milestones of Recovery Score (MORS) Adult
2018-05-25
Milestones of Recovery Score (MORS) Explanation Sheet
2018-02-13
PSC-35 Explanation Sheet Rev 11.15.24 (docx)
Revised 11/15/2024 2024-11-16
Prior Authorization Day Services Request - IOP/PHP (C/Y)
Revised 04/01/2022 2022-03-25
Prior Authorization Day Services Request - IOP/PHP (C/Y) Explanation Sheet
2022-06-13
Psych Medical Service Note
2024-10-17
Psychiatric Assessment
2018-02-13
Psychiatric Assessment Explanation Sheet
2019-12-12
Recovery Markers Questionnaire Form 093009 (pdf)
2020-07-14
Release of Information
2023-08-21
Release of Information - Child/Youth
2017-02-17
Release of Information Explanation Sheet
2018-02-09
Risk Assessment
2024-09-11
Risk Assessment Explanation Sheet
2024-09-11
Safety Plan
2024-09-11
Safety Plan Explanation Sheet
2024-09-11
Service Note (pdf)
Revised 10/17/2024 2024-10-24
Substance Abuse Treatment Scale (SATS-R)
2017-03-02
Substance Abuse Treatment Scale (SATS-R) Explanation Sheet
2018-02-13
TADT (Timely Data Access Tool)
2024-09-11
Youth Transition Self-Evaluation (YTSE)
2020-06-18
Youth Transition Self-Evaluation (YTSE) Explanation Sheet
2021-08-20

UTTM

Please go to the new MH & DMC-ODS page’s UTTM tab to access files. This tab is in the process of being sunset.

Training

Please go to the new MH & DMC-ODS page’s Training tab to access files.  This tab is in the process of being sunset.

PWB

Please go to the new MH & DMC-ODS page’s MH Resources tab to access files. This tab is in the process of being sunset.

STRTP

Please go to the new MH & DMC-ODS page’s MH Resources tab to access files. This tab is in the process of being sunset.

TFC

Please go to the new MH & DMC-ODS page’s MH Resources tab to access files. This tab is in the process of being sunset.

TBS

Please go to the new MH & DMC-ODS page’s MH Resources tab to access files. This tab is in the process of being sunset.

Billing Unit/Finance

Please go to the new MH & DMC-ODS page’s Billing tab to access files. This tab is in the process of being sunset.

SmartCare

Please go to the SMH & DMC-ODS Health Plans page’s SmartCare tab to access files. This tab is in the process of being sunset.

Serious Incident Reporting

Please go to the new MH & DMC-ODS page’s SIR tab to access files. This tab is in the process of being sunset.