Providers & Professionals
Thank You For Helping Us Offer Integrated Care
At Pivotal, we value the relationships we hold with our contracted providers and professionals in St. Joseph County. With your help, we offer wellness, hope, and recovery to the citizens we serve.
We continually maintain a comprehensive network of specialized services and supports are in place that are sufficient in amount, scope and duration to meet the needs of all eligible persons requiring specialty benefit mental health and substance use services. Pivotal reviews provider performance relative to Federal, State and local requirement, network expansion, cost reduction and quality improvement. The Southwest Michigan Behavior Health (SWMBH) maintains the Provider Network Directory of all the service providers within our 8 county region.
Interested In Becoming A Provider?
Give Jarrett Cupp, Chief Compliance Officer/Director of Provider Network, a call at 269-467-1001 ext.353 or email jcupp@PivotalStJoe.org.
Provider Policies and Procedures
• SWMBH Provider Policies & Documents
• Provider Directory
• MDHHS Homepage
• Provider Grievance & Appeals
• Provider Appeal Process
• Provider Contract Compliance
• Credentialing and Re-Credentialing (Individual Providers)
• Credentialing and Re-Credentialing (Organizational Providers)
• Exclusion for Provider Network
• Provider Network Monitoring
• Subcontracting
• Notification of Change in Network
• Incident Reporting
• DHHS Incident Accident Report
• Recipient Death Report
• Emergency Use of Physical Management
• Pivotal Property Incident/Accident/Illness Incident Report
• Definitions Related to Incidents and Events
• Consumer Death and Sentinel Event Reporting
• Customer Service Policy
• Accessibility and Accommodations
• Second Opinions/Grievances and Appeals/Disputes Resolution
• Advance Directives
• Claims Management
• Accounts Payable Invoice Processing
• Customer Plan Coverage/Eligibility Determinations
• Corporate Compliance
• Recipient Rights of Substance Abuse Customers
• Self-Determination Policy
Provider Training
• Provider Access Form for EHR (Electronic Health Record)
• SWMBH Compliance Training
• SWMBH Customer Service Concepts Training
• SWMBH Grievance, Appeals, and Notices Training
• SWMBH Limited English Proficiency Training
• Operating Policy & Procedure Training Requirements
• Staff Competency Training
**Provider Notice and Notice for Families with Medicaid-Eligible Youth
The Michigan Department of Health and Human Services (MDHHS) has received preliminary court approval for the settlement of litigation alleging that medically necessary intensive home and community-based services were not timely provided to Medicaid-eligible children and youth as required by Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions. This litigation is known as D.D. v. MDHHS; formerly known as K.B. v. MDHHS.
The Class Action Notice, which outlines a summary of the settlement’s terms, as well as the full Agreement, can be found on the MDHHS website. Class members include all Medicaid-eligible beneficiaries under the age of 21 in the State of Michigan for whom a licensed practitioner of the healing arts acting within the scope of practice under state law has determined, through an assessment, that intensive home and community-based services are needed to correct or ameliorate their emotional, behavioral, or psychiatric condition.
For questions or more information, refer to the settlement Agreement or email MDHHS-BCCHPS-Questions@michigan.gov.