24/7 Crisis Help Line: 877-470-4668

Access to Services: 877-470-7130

Customer Services : 877-470-3195

 

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Client Portal

North Country CMH
Contract Provider Administrative Resources

Policies and Procedures
Manual

Provider Time Study
Instructions

Provider Instructions for Time Studies

Time Study PDF Template

Time Study Example 1

Time Study Example 2

Time Study Calculating Template

Provider Forms

Acknowledgement of Training Hub, Requirements, and Provider Resources

Application 

Background Check Release Form

EFT Vendor Authorization for Direct Deposit

Entity Disclosure of Ownership

False Claims Attestation

Federal Form W9

Guidelines for Proof of IPOS Training Form

NorthStar User Verification Form

NorthStar System New User Request Form

Respite Care Invoice

Respite Provider Application

Staff Transcript Request Form

Subcontractor Disclosure of Ownership

Workman’s Compensation Exclusion Statement

Contract Provider Policies and Procedures

Administration

Risk Management Policy

Risk Management Procedure

Environment of Care

Contract Site Review Procedure

Health Services

Controlled Substances in Board Residential Programs Procedure

Medication Administration in Day Programs Procedure

Psychotropic and Other Medications Policy

Human Resources

Code of Ethics Policy

Member Rights

Abuse and Neglect Procedure

Advance Directives Policy

Comprehensive Assessment Policy

Confidentiality Use and Disclosure Procedure

Dignity and Respect Policy

Family Planning Policy

Fingerprinting Photography Audio-Video Use of One-Way Glass Policy

Grievance and Appeal Procedure

Informed Consent Procedure

Recipient Rights Policy

Recipient Rights Procedure

Religious Worship Policy

Resident Communication and Visitation Procedure

Resident Freedom of Movement Policy

Resident Labor Policy

Resident Right to Entertainment, Information, and News Procedure

Residential Property and Funds Procedure

Restraint, Seclusion, and Physical Management Policy

Services Suited to Condition Policy

Quality Improvement

Claims Validation and Record Review Procedure

Quality Improvement Plan

Contract Provider Manual

Contract Services

Application for Credentialing (Will Automatically Download When Clicked)

Exclusions Attestation Form

Hand Washing Poster

Inclusion Practice Guideline

NCCMH Infection Control and Safety Manual

Recipient Rights Book

Subcontractor’s Notice on Worker’s Compensation

Financial Services

CLS Activity Log (Will Automatically Download When Clicked)

Competitive Employment Status Report

Home Census Reporting Form

Invoice, Daily CLS (Will Automatically Download When Clicked)

Invoice Hourly CLS (Will Automatically Download When Clicked)

Invoice, Residential (Will Automatically Download When Clicked)

Mileage Log Sheet 

Supported Employment Activity Log (Will Automatically Download When Clicked)

Regulatory Requirements

Advance Directives Education

Application for Renewal and Recommitment

Cultural Competence and Limited English Plan

False Claims Act

False Claims Attestation Form

HIPAA 2-Page Summary

Incident Report Form

Incident Reporting Guidelines

MDHHS Requirements for Reporting Abuse and Neglect Poster

Medicaid Definition of Developmental Disabilities

Medicaid Provider Manual

Mental Health Code, Chapter 7

NCCMH Preventing Sexual Harassment

Regulatory Compliance Plan

Title 42 Confidentiality of Patient Records

Whistleblowers Protection Act

Whistleblowers Protection Act Poster