November Provider Forum this Tuesday – Register Today!

The November 8, 2016 Provider Forum will spotlight the various departments at Partners. It is a great chance to learn about each of the departments and any changes in their scope of work.

What: Quarterly Provider Forum

When: Tuesday, Nov. 8, 2016

Time: 1 p.m.

Where: Teleconference between Partners’ Elkin, Gastonia, and Hickory offices.

To register, select the location where you will attend:

If you have questions regarding the forum, please contact your Account Specialist. Handouts from previous forums are available on the Provider Forums page.

Retro Medicare/Third Party Liability Processing

NCTracks implemented Retro Medicare/Third Party Liability (TPL) Processing as of September 25, 2016. State Benefit (formerly known as IPRS) Claims billed will be handled the same as the current retro-Medicaid process, except it looks for both Medicare and Third Party Insurance. You, the provider, may start to see recoupments on your remittance advice.

Partners’ Claims Department staff will attempt to have Medicare/TPL information added in AlphaMCS and claims will be re-adjudicated to process against coordination of benefits edits. If insurance information is unobtainable, the claim will revert due to Other Primary coverage. This edit only applies to codes that are not listed on Partners Medicare/TPL bypass list.

Medicare Third Party Liability Bypass Codes can be located on the Partners’ Provider Knowledge Base website at http://providers.partnersbhm.org/claims-information/.

Clinical Coverage Policy 8P Amended

On November 1, 2016, the Division of Medical Assistance posted an amended version of Clinical Coverage Policy 8P to reflect NC Innovations technical amendment changes. The currently posted CCP 8P is missing the Crisis Services Definition. DMA is aware of the error and is correcting the document.

You can find all Behavioral Health Clinical Coverage Policies at https://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies.