Contract Providers

DBH FORMS & PROCEDURES

Departmental Forms - The purpose of this page is to provide a centralized location to access all the forms used in the Department of Behavioral Health.

CDI Correction Form - The purpose of this form is to submit the processing of service deletions and corrections in the San Bernardino Information Management Online Network (SIMON) using a Charge Data Correction Invoice. For MHS submit form to DBH Contracts Office (909) 387-7592.

Universal CDI - The purpose of the Charge Data Invoice (CDI) is to provide data relevant to services that have been provided so that billing or other cost allocation may be done.

Episode Transfer Procedure - The purpose of this procedure is to transfer an episode from one reporting unit number to another.

Medi-Cal Certification Process - To establish the departmental procedures to control and monitor the Medi-Cal certification process for a contract provider who has a valid contract with the department and has requested certification. Certification allows the provider and subsequently the department to bill the State Department of Mental Health for Medi-Cal services. The certification process will normally be twenty-two to thirty-one days in duration.

Staff Master Worksheet - The information obtained on this form will be used for assigning a “SIMON” number for computerized billing and preparing your Medicare PIN application. This form must be completed by the end of the employee’s second day of employment.

Staff Master Worksheet Update - The information obtained on this form will be used to update current “SIMON” number holder's information for computerized billing. This form must be completed whenever there is any changes such as renewed license date, change of name, etc....

State Informing Materials - Consumer Guides

DBH MANUALS

MHS Reference Manual - This is the MHS Reference Manual that is distributed to all InSyst (SIMON) trainees during training. This manual has all the data entry/look-up instructions for all clerical duties related to Simon.

ADS Reference Manual - This is the ADS Reference Manual that is distributed to all InSyst (SIMON) trainees during training. This manual has all the data entry/look-up instructions for all clerical duties related to Simon.

ASG Ancillary Reports Manual - These reports are created by the Applications Services staff for the users and are submitted by ASG operations staff and users to routed printers automatically upon completion of the reports.

InSyst User Guide - This is the InSyst User Guide that has all the data entry/look-up instructions for all InSyst (Simon) related duties.

InSyst Reports Reference Guide - These reports are created by the Echo Group staff as a guide to help users understand reports generated by the InSyst application.

InSyst Update - This release contains bug fixes, new modules, and enhancements to existing functionality.

Standard Practice Manual - Please see the Department of Behavioral Health Standard Practice Manual, which describes the role and function of each office, as well as the policies and procedures that guide us in the delivery of high quality services.

Outpatient Chart Manual - Please visit the Department of Behavioral Health Outpatient Manual to review the processes, procedures, and forms that accompany treatment and service delivery.

Code of Conduct - This Code of Conduct sets the tone of operation and specifies the values of the organization. All staff and volunteers must strictly adhere to this Code of Conduct

Cultural Competency Plan - The state of California continues to experience population growth in various ethnic groups. Population growth has presented several cultural and linguistic challenges. According to the Surgeon General's Report, Mental Health: Culture, Race and Ethnicity 2001 and the Little Hoover Commission 2000, "minorities receive treatment at a rate that is even lower than that of the general population. Ethnic minority populations appear to bear a greater burden from unmet mental health needs and suffer a greater loss to their overall health and productivity". "As California's population has grown in size and diversity, the mental health system has strained to keep up with the need for care (Little Hoover Commission)".

DBH Links

Mental Illness Arrest - What Do I Do - A step-by-step guide to help families cope with the criminal justice system in San Bernardino County when a family member who suffers from a mental illness is arrested