Provider FAQ
Welcome to Fresno County Mental Health Plan’s (FCMHP) Frequently Asked Questions. Here you will find answers to the most often asked questions. These questions fall into nine categories. Please contact us if you need additional clarification.
If you do not find your question on the list, please e-mail us, and we will be happy to research it for you.
Can I schedule a two-hour block to do the assessment?
Yes. You may schedule your assessment either in a two-hour block of time or (if more convenient to your needs and those of your client) in two sessions of one hour each.
If it takes two separate sessions to complete an Assessment, can I submit the completed Assessment and treatment plan in a single submission?
Yes. Although your assessment may require two visits, on two different days, you are only required to submit one completed Assessment form. The treatment plan is the last page of your assessment and must be submitted with your completed Assessment.
Is the client’s signature required on both the Assessment and treatment plan forms?
No. The client’s signature is required only on the treatment plan; the clinician must sign and date both the Assessment and the treatment plan.
Does the client’s treatment plan have to be completed on the date that you saw the consumer?
No, but it must be completed, submitted, and services authorized before billable services may be rendered.
What date should be on the treatment plan?
The clinician should document the date the plan is completed.
If I receive a feedback letter for a missing signature, should I submit a new treatment plan or return the same one with my signature?
No, obtain the client’s signature on the next visit and keep the record on file. The MHP will review this document during the audit.
For situations that change, is a new treatment plan required?
Yes. Changes to service requests or additional services require an amended authorization and a modification to your existing treatment plan.
What kinds of documentation denote how the client is doing?
Ideally, the treatment plan you develop for the client will detail specific, observable, or measurable mental health symptoms or behaviors that are problems for the client. The stated objectives will also be specific, observable, and measurable changes in the identified symptoms/behaviors. Change or lack of change in those symptoms/behaviors will be an indicator of how the child is progressing and must be documented in the progress notes.
Should individual service types be included in the progress notes for family services?
The notes should address the service being billed. For example, if you bill for a family session, the notes should reflect that.
Do I have to submit notes for each family member?
No, you only need to submit notes for the Medi-Cal beneficiary you are authorized to treat.
If I have a request to work with a divorce case where they want marriage counseling and also see the family, say we’re seeing two of the kids, and we want to see them individually, what do we put in the progress notes?
Marriage counseling is not covered by Medi-Cal. If you have been authorized to see one of the parents for an identified Medi-Cal included mental health diagnosis and are billing the family sessions under that parent’s name, you will not be able to work individually with the children under that parent’s name. You will need to verify the two children's Medi-Cal eligibility and request services for each child individually.
What types of services require authorization?
Pre-authorization of services is only required for Therapeutic Behavioral Services, and for minors who are court dependents of other counties placed in foster care or group homes in Fresno County. Outpatient Specialty Mental Health services do not require pre-authorization.
How do I request a Service Authorization Request (SAR) for a minor who is a court dependent of another county (placed in foster care or group homes in Fresno County)?
When checking a minor's Medi-Cal eligibility, you may occasionally discover that they have Medi-Cal eligibility from another county. If these minors are court dependents of another county who are placed in foster care or group homes in Fresno County, you must contact the SAR Coordinator at (559) 600-4645 as soon as possible to acquire the appropriate authorization to treat the minor beneficiaries. See your Provider Manual for more information, specifically the section "Services Requiring Authorization".
Can I bill for different service(s) than those I already have authorized?
You may, however, be paid only for services that have been pre-authorized.
What is considered the receipt date of an authorization, the date faxed, or the date reviewed?
If a request for authorization is faxed or sent via encrypted email, the fax date is considered the date of receipt. If a request for authorization is mailed, the date received at the Managed Care office is considered the receipt date.
If I submit an authorization but it can’t be found, will it still be honored?
All authorization requests are logged; any logged request will be honored. However, if we have no record that it was received/logged, then you must submit another copy showing the original fax date. If the request was logged but we cannot locate the paperwork, we will honor the log date and request that you submit another copy.
Can I schedule an appointment with the client beyond the assessment before receiving authorization?
You can, but at your own risk of not being paid. Claims for services provided before the authorization start date will usually be denied.
If six members of a family are listed, is a separate form required for each member?
As the clinician, you must decide who is/are the primary client(s). If you wish to provide individual or group sessions, you must complete an Assessment for each individual for whom you wish to provide those services. If you wish to include family members in the primary client’s treatment, you do not need to complete an Assessment for them.
Am I required to use the MHP’s consent form?
No. Although a signed Consent for Treatment is required documentation in the consumer’s chart, the MHP’s consent form is provided to you only as an example of items and wording you may want to include in the form you use or develop.
Can foster parents sign the Consent form?
Caution is advised in foster parent situations because it depends upon whether the child has been placed with foster parents (a) by court order or with the consent of the legal guardian, or (b) on a temporary basis before a detention hearing has been held. If the court orders placement of a child with foster parents, and mental health assessment and/or treatment, the foster parent may sign the consent for treatment form. Written evidence of the foster parent’s authority (e.g., a copy of court order documents or the consent of the child’s parent or legal guardian) should be placed in the chart. Foster parents with temporary custody before a detention hearing and a court-ordered placement do not have the authority to consent to treatment.
Does the authority to consent to treatment include foster families and agencies that work with CPS and CASA cases?
See previous question.
Am I required to report physical violence if the child informs me that this is happening?
California Penal Code sections 11164 through 11174.3 require a “child care custodian” or “health practitioner” who has knowledge of or reasonably suspects a child has been a victim of abuse to report such instances of child abuse to a child protective agency immediately or as soon as possible by telephone, and by written report within 36 hours. A “child care custodian” includes, among others: social workers, teachers, teacher’s aides, licensed day care workers, probation officers, parole officers, and family support officers. A “health practitioner” includes, among others: a physician, a psychiatrist, a psychologist, a marriage and family therapist, and a clinical social worker.
Does the MHP want the signed consent-to-treatment form?
The signed consent for treatment form should be filed in the consumer’s chart, and Managed Care staff will verify this during audits. The consent for treatment form should be signed by the parent, legal guardian, or other person authorized to give consent. A social worker or probation officer may consent to treatment if so ordered by the court. Request written evidence of that authority.
For minors, should we use the guardian, parent, or foster parent for the consent-to-treatment signature, and does it need to be an original signature?
The parent should sign the treatment consent form unless the child is in the legal custody of someone else, and that person has been authorized to consent to treatment. Again, ask for written evidence appointing a legal guardian, foster parent, or other with authority to consent to treatment. Place copies in the consumer’s chart. The original signature on the consent for treatment form should be filed in the consumer’s chart.
What is the process for an appeal of a denied claim?
Providers may appeal a dispute with the FCMHP regarding the processing or payment of a provider's claim to the FCMHP. Please refer to Section 6.0.2.1 of your Provider Manual for more information.
For an assessment, bonding study, should Box 21 (diagnosis) be completed?
Yes, Box 21, the diagnosis, must always be completed for any service provided.
On the HCFA 1500 form, do I have to bill the amount that is on the MHP fee schedule?
No, but you should bill at least the amount on the MHP fee schedule. The MHP will pay the lesser of the billed amount or the fee schedule amount.
What is the purpose of Box 24E (diagnosis code)?
This identifies the primary authorized diagnosis and the diagnosis code submitted to the Medi-Cal program.
What is the billing process when third-party insurance is involved?
You need to obtain the consumer's billing information, then bill the other coverage first. They have 60 days to issue a payment or a denial. After receiving a denial or partial payment, the provider has 30 calendar days from the date of denial/Explanation of Benefits (EOB) to bill Managed Care. Please contact your Provider Relations Specialist.
What does the “F” mean after the service code?
This is a suffix identifier unique to Fresno County codes.
Where do I find the authorization number to put in Box 23?
This number is on the approved authorization that you receive after submitting a request. The authorization number must be submitted on all claims for services requiring authorization.
Where do I get the Eligibility Verification Confirmation (EVC) number?
Section 4 of your Provider Manual will explain how to access AEVS to perform eligibility verification, where you will be issued an EVC number, or you may access the Medi-Cal website at https://www.medi-cal.ca.gov/Eligibility/Login.asp
If the consumer is a Fresno County beneficiary and is later switched to another County, will I be paid for those services after the County change?
No, it is the provider’s responsibility to verify the consumer’s eligibility before delivering services.
Can I bill an assessment provided to a physically disabled consumer?
Yes, provided that you are assessing for an included mental health diagnosis.
Can I bill an assessment for a severely developmentally delayed client if he/she has some other included diagnosis, i.e., depression?
Yes, provided that you are assessing for an included mental health diagnosis.
Can I bill for “no shows”?
No, please see section 4.3 in your provider manual.
If there are two or more diagnosis codes, must the diagnosis always be entered in Box 21?
Yes, you must enter the primary authorized diagnosis in Box 21, line 1; any other diagnosis(es) should be listed in the appropriate order.
How is the claim completed if a two-hour assessment is completed in two different one-hour sessions?
Both sessions should be entered as separate entries, showing each date of service in Box 24.
Will the claims' submission period ever be extended from 30 days to 60 days?
Not at this time, however, we may re-evaluate this policy in the future.
If I am providing only an assessment and no further treatment for a client, can I send in an HCFA form without a diagnosis, or can I use a rule-out diagnosis?
You need to use an included mental health diagnosis. A rule-out diagnosis is acceptable as long as it is among the included mental health diagnoses.
Do you cultivate jobs out in the community for mental health consumers?
Supported Employment and Education Services provides supported employment that is paid work in a normal, integrated work setting. Staff engage in job development and support consumers with follow-along services once they are on the job to help them overcome problems that may affect their productivity and effectiveness. Work evaluation and work adjustment activities are also components of the program. Supportive education services are provided to adults returning to school or already pursuing their GED, including those taking community college, state college, or adult education classes.
Do I have to use the MHP forms?
Yes. Effective 7/1/00, providers must use the forms developed by the MHP. These forms include information required by the State Medi-Cal program.
Is there a list of all included diagnoses?
Yes, see Section 4 in your provider manual.
What can be done to stop the foster parent(s) from missing scheduled appointments? Are there any consequences for them?
Notify the CPS worker who will intervene on the child’s behalf.
Can I refuse to see a consumer if the parent or foster parent has missed many consecutive appointments and hasn’t called?
Yes. The caregiver should be made aware of your policy in advance.
Can you briefly explain the Cal-Works program?
Cal-Works is California’s version of Welfare to Work. TANF (formerly AFDC) recipients are assigned to a Job Specialist who works with them to overcome barriers to employment. Mental Health’s part in this is called the Employment Services Program (ESP). Job Specialists use a mental health screening tool to assess their clients. If mental health problems are suggested by the results of the screening tool, the client is sent to ESP for an assessment by a mental health clinician. If the client has a mental health problem sufficiently serious to meet Medi-Cal’s medical necessity criteria, the client will receive services from the ESP staff and may also be referred to a contract provider for individual/group therapy or medication evaluation (currently through Fresno County Mental Health Adult Outpatient Services). Clients who do not meet medical necessity are still eligible to receive non-Medi-Cal billable services from ESP staff, including group and case management services. The ESP staff have completed orientation with the Job Specialists and assist clients in understanding and meeting Cal-Works expectations.
Do I indicate if the client is Cal-Works? If so, where?
Yes. You must document if a client is referred by Cal-Works, as this is a CSI reporting requirement. There is a space to document this information on the Assessment and Reauthorization forms.
How do I change a diagnosis after the assessment?
Note the change in diagnosis in your Progress Notes and attach a copy of that note with your claim. In addition, add a change in diagnosis to the current assessment or reauthorization request, including the date and initials, so the change is clear at the time of audit.
Do I need to include a numeric DSM code and its description on the assessment or reauthorization request?
Yes.
What do I need to do, and what is required to discharge a client?
Complete a discharge summary and send it to the Managed Care office as soon as it is clear that you will not be continuing services with the client.
What is the Crisis Stabilization Center? Where is it located? Is it part of Fresno County?
The Crisis Stabilization Center provides assessment, crisis intervention, and crisis stabilization services 24 hours a day, 7 days a week. It is no longer operated directly by the County of Fresno. The Crisis Stabilization Center is operated by a contracted organizational provider. It is located at 4411 Cesar Chavez Blvd, Fresno, CA 93702.
Contact Us
Fresno County Mental Health Plan
P. O. Box 45003
Fresno, CA. 93718-9886
Contact Info
Phone: (559) 600-4645
Fax: (559) 455-4633
TTY: 711
For billing questions, contact Managed Care at (559) 600-4645 and ask to speak with a Provider Relations Specialist.
For authorization questions, contact Managed Care (559) 600-4645 and ask to speak to a Utilization Review Specialist.