Notice of Adverse Benefit. Determination (NOABD): Contractor shall immediately notify BHRS of any action that may require a NOABD be issued to a beneficiary, including, but not limited to: failing to provide the beneficiary with an initial face-to-face assessment appointment within three business days of the request for Opioid Treatment Programs or 10 business days of the request for all other substance use services; or determining that a beneficiary does not meet medical necessity for any substance use disorder treatment services. Contractor shall have written procedures to ensure compliance with the County’s NOABD Procedure as outlined on the County website XxxxxXXXX.xxx including the following: 1) Contractor shall request consent from beneficiaries to issue a NOABD to the address on record should covered services be reduced, denied, modified, delayed or terminated; 2) Contractor shall log the NOABD on the Provider NOABD Log and submit by the 10th of each month via encrypted email to the County with copies of the issued NOABDs. Aligned with MHSUDS 18-010E and 42 C.F.R. § 438.404, the appropriate and delegated NOABD must be issued by Contractors within the specified timeframes using the template provided by the County. [BHRS-33]
Notice of Adverse Benefit. Determination (NOABD): Contractor shall immediately notify BHRS of any action that may require a NOABD be issued to a beneficiary, including, but not limited to: failing to provide the beneficiary with an initial face-to-face assessment appointment within three business days of the request for Opioid Treatment Programs or 10 business days of the request for all other substance use services; or determining that a beneficiary does not meet medical necessity for any substance use disorder treatment services. Contractor shall have written procedures to ensure compliance with the County’s NOABD Procedure as outlined on the County website XxxxxXXXX.xxx including the following: 1) Contractor shall request consent from beneficiaries to issue a NOABD to the address on record should covered services be reduced, denied, modified, delayed or terminated; 2) Contractor shall utilize SmartCare to issue NOABDs, or if not using the full clinical functionality of SmartCare, shall log the NOABD on the Provider NOABD Log and submit by the 10th of each month via encrypted email to the County with copies of the issued NOABDs. Aligned with MHSUDS 18-010E and 42 C.F.R. § 438.404, the appropriate and delegated NOABD must be issued by Contractors within the specified timeframes using the template provided by the County. [BHRS-33]
Notice of Adverse Benefit. Determination Requirements 363 A.2.14.8 Medical History Information Requirements 364 A.2.14.9 PCP Profiling 364 A.2.15 QUALITY MANAGEMENT/QUALITY IMPROVEMENT 365 A.2.15.1 Quality Management/Quality Improvement (QM/QI) Program 365 A.2.15.2 QM/QI Committee 367 A.2.15.3 Performance Improvement Projects (PIPs) 367 A.2.15.4 Clinical Practice Guidelines 368 A.2.15.5 NCQA Accreditation 368 A.2.15.6 HEDIS and CAHPS 370
