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Case Worker
⛔ Non-Billable per OMHSAS-24-05 §E(1)(f)(vi): Unsuccessful contact attempts must be documented but are non-compensable. These records do not appear in the Claims Queue.
Generate and print CPS referral forms for this participant.
CPS Referrals
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Billing & Claims
Date
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Rendering CPS
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Track CCBH prior authorizations for H0038 per participant. Units used are calculated automatically from signed individual and group session notes within the authorization date range.
Participant
Auth #
Date Range
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Units Used
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These settings appear on every exported claim line. Leave fields blank until your CCBH contract and provider enrollment are finalized — the Claims Queue will still track every billable encounter.
Organization / Billing Provider
Clearinghouse
The Claims Queue CSV export contains all standard 837P-relevant fields. Match column layout to your clearinghouse import template.
Procedure Code Modifiers
One per line — format: CODE - Description. Modifier FQ (audio-only telehealth) confirmed per OMHSAS-24-05. HQ (group) confirmed per OMHSAS PSS billing rules.
Per-Participant CCBH / Authorization Info
Select a participant above to view or edit their authorization details.
Forms & Templates
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⚠️ Compliance Gaps
OMHSAS-24-05 documentation requirements
📊 Service Utilization by Participant
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👤 Units of Service by Staff
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📅 Monthly Session Summary
Month
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Admin — User Management & REVAMP Applications
REVAMP Applications
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Staff Accounts
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CPS Referral Form — Allegheny County DHS
Section 1 — Demographics
Section 2 — Referral Information
Section 3 — Eligibility & Clinical
✅ Consent: Participant verbal/written consent to release information obtained prior to referral submission.
Add Participant
OMHSAS / Clinical
Add Note
Individual Progress Note — OMHSAS Peer Support Services
⚠ Per OMHSAS requirements, this note must be completed and signed within 24 hours of the service date.
Session Information
For transit/community locations, select 99 and note below.
Required by OMHSAS-24-05 when service is in transit or a community location.
ISP Goals & Objectives Addressed
Select all ISP goal areas addressed this session and document the intervention/progress for each. At least one is required.
Overall Session Summary
Signatures
By signing, both parties certify the service was rendered as documented. Payment will be from Federal and State funds — false claims may be prosecuted.
MHP / Supervisor Review
Per OMHSAS-24-05: ISPs, 6-month summaries, and discharge summaries require MHP co-signature. For standard progress notes, supervisor review is best practice — document here if reviewed.
Add Addendum
The original signed note cannot be altered. This addendum will be appended with its own date, author, and signature — preserving a complete audit trail.
New Appointment
Appointment Details
Form Template Builder
Form Fields
No fields yet — click "Add Field" to begin.
Complete Form
Completed Form
Add Staff Record
Credentials
Contact & Employment
Individual Peer Recovery Plan (IPRP)
Plan Information
OMHSAS-24-05 Eligibility & Authorization
Participant Profile
Recovery Goals & Action Steps
Click "Add Recovery Goal" to begin building the recovery plan.
Signatures & Attestation
Upload Document
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Log Contact Attempt
This record is non-billable per OMHSAS-24-05 and will NOT appear in the Claims Queue. It is kept in the participant's record to document due diligence in attempting to reach the individual.
Reminder: Per OMHSAS-24-05 §III.B, unsuccessful contact attempts are non-compensable and must NOT be billed to Medicaid. This log fulfills the documentation requirement without generating a billable claim.
Add Billing Entry
Group Session Note — OMHSAS Peer Support Services
⚠ Per OMHSAS requirements, this note must be completed and signed within 24 hours of the session date. Billing modifier HQ is required for all group sessions.
Group Session Details
Attendance
Select all participants who attended this session. Only enrolled participants are shown.