NorthSTAR Contract: FY 2011 - FY 2013

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ValueOptions Contract and Appendices — September 1, 2011 - August 31, 2013

Contract

ValueOptions Contract

FY12 General Provisions Vendor

Appendices

(0) Table of Contents

(1) Definitions

(2A) Medical Records Standards

(2B) Crisis Redesign Service Standards

(3A) Coordination Agreement STAR-NorthSTAR

(3B) Coordination Agreement - CHIP-NorthSTAR

(4A) Performance Incentives Outline Revision posted February 28, 2012

(4B) Performance Penalties Revision posted February 28, 2012

(5) Over Capacity Plan

(6) Medicaid Eligibility Criteria Grid

(7) Mental Health Priority Population

(8A) Scope of Benefits (Mental Health)

(8B) Scope of Benefits (Chemical Dependency)

(9) Special Children’s Programs

(10) Outpatient Competency Restoration Programs Revision posted April 5, 2013

(11) Medicaid Rate Setting Methodology

(12) Coordination of Care Between CRCGs and BHO

(13A) Assessment Instrument: Adult

(13B) Assessment Instrument: Child

(14) Provider Credentialing and Recredentialing

(15) Financial Eligibility Determination Form

(16) Pharmacy Guidelines

(17) Financial Statistical Report BHFSR

(18) Historically Underutilized Business (HUB) Report

(19) Utilization Review for Chemical Dependency

(20A) Data Submission Specs - Encounter

(20B) Data Submission Specs - Error to BHO Adult UA

(20C) Data Submission Specs - Error to BHO Kids UA

(20D) Data Submission Specs - From BHO DX

(20E) Data Submission Specs - From BHO Kids UA

(20F) Data Submission Specs - From BHO PBM

(20G) Data Submission Specs - From BHO Provider

(20H) Data Submission Specs - From BHO Taxonomy

(20I) Data Submission Specs - To BHO Dx

(20J) Data Submission Specs - To BHO Kids UA

(20K) (Data Submission Specs - To BHO Adult UA

(20L) Data Submission Specs - To NS Adult UA

(20M) Data Submission Specs - To NS Dx

(20N) Data Submission Specs Enro-Auxil

(21) Training and Competency Requirements NEW Posted April 5, 2013

(22) Service and Lab Codes

(23) Enrollee and Provider Complaints and Appeals

(24A) Provider Network Change Report – Individual Provider

(24B) Provider Network Change Report – Facility Provider

(25) Cannabis Youth Treatment Services

(26) Drug Formulary

(27) Case Management and Rehabilitative Services

(28) Confidentiality Agreement

(29) Quality Improvement Report

(30) Estimated NorthSTAR Services Budget Revision posted February 28, 2012

(31) Anti-Fraud Plan

(32) Quality Strategy

(33) Adverse Determinations and Appeals

North Texas Behavioral Health Authority (NTBHA) Contract and Documents

NTBHA Contract

Exhibits

Categorical Budget

Equipment List

 

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Last updated December 06, 2013