Partners’ administrative offices will be closed on Monday, January 20, 2020, in observance of the Martin Luther King, Jr. holiday. Our Access to Care Call Center will be available 24 hours a day, and our Utilization Management Acute Services Team will be available from 8 a.m.-7 p.m.
January Provider Council Meeting
Partners’ Provider Council will host its next meeting on Friday, January 24, 2020, from 9:30 a.m.-12 p.m. in the Multipurpose Room at Partners’ Hickory location, 1985 Tate Blvd. SE, Hickory, NC 28602. Providers will meet from 9:30 a.m.-10:30 a.m. Partners’ employees will join the meeting at 10:30 a.m.
Provider Council officers for 2020 are:
Beth Brown, Phoenix Counseling Center, Chair
Alicia Emmons, Developmental Disabilities Resources, Inc., Vice-Chair
Teagan Brown, A Caring Alternative, Secretary
Providers offering appointments through the AlphaMCS Slot Scheduler need to ensure that their appointment slots are accurate in the slot scheduler and are entered two weeks in advance. Please make sure to note the following when entering appointment slots:
- Correct operating hours, especially during holiday periods
- Type of funding and clients served (Medicaid or State)
In addition, please contact Access to Care if your office or site closes due to inclement weather. This will assist us in providing the best service to our members. If you have any questions, please contact Access to Care at 1-888-235-4673.
Reminder of After-Hours Coverage and Crisis Plan Requirements
As a member of the Partners’ provider network, you have a responsibility to ensure clinical coverage for members after hours. This will help reduce unnecessary visits to the emergency department (ED) for behavioral health concerns that could better be managed by your clinical teams. To ensure compliance with this requirement, Partners periodically engages in “mystery shopping” calls to verify after-hours protocols; we also conduct crisis plan audits.
Please review Partners’ network provider requirements below and as outlined in the Partners’ Provider Operations Manual as well as service definitions and NC Department of Health and Human Services clinical coverage policies.
Below are guidelines and requirements for your after-hours protocol and a sample script for voice mail messages. Providers must:
- Have a clinical backup system in place to respond to all crises/emergencies for members receiving services. This includes:
- Crisis plans that are available to the providers’ clinicians, members and their natural supports, and Partners’ Access to Care Department
- Information and directions on how to seek assistance in a crisis/emergency:
- Posted office hours, weekends, evenings and holidays for all members being served
- Voicemail systems updated and monitored
- Voicemail message specifies mental health, substance use, or psychiatric crisis for after-hours coverage phone number
- Have a 24/7/365 telephone number for members to contact you in the case of an MH/DD/SA crisis or emergency.
- This contact may not be:
- 911 (unless specified for medical emergencies)
- Directing the member to the emergency department for non-medical crisis
- The Partners Access to Care Department
- A hospital or Mobile Crisis Team (unless a contracted arrangement exists)
- This contact may be a subcontracted backup contact person who:
- Has the qualifications, training and capacity to navigate the range of MH/DD/SA crisis scenarios a member may experience
- Advises the member and assists in the coordination of care during the crisis
- Is available telephonically or in-person if the situation requires
- Has immediate access to crisis plans for members who have them
- Sample script for voice mail messages for after-hours coverage:
- This contact may not be:
You have reached [Provider Name] [Provided Service]’s after-hours first responder line. If this is a medical emergency, please hang up and dial 911. If you, or your family member, are currently receiving [Service Type] services and need immediate assistance, please press [Designated Key or Number Sequence] to speak with a member of our team. For all non-emergency mental health or substance use service-related calls, please press [Designated Key or Number Sequence] to leave a voice mail that will be answered the next business day. Thank you for calling [Provider Name] [Provided Service]’s after-hours first responder line.
Utilization Management Updates
Attention Research Based Behavioral Health Treatment Providers: Frequently Asked Questions regarding RB-BHT (Research Based-Behavioral Health Treatment) are now available on the NC DHHS website at https://medicaid.ncdhhs.gov/providers/programs-services/mental-health/behavioral-health-services.
Autism Services Learning Collaborative: Partners’ next Autism Services Learning Collaborative will be scheduled via a poll through Doodle.com. Please look for the Doodle poll e-mail sent on January 7, 2020. The Doodle poll will close on Friday, January 21, 2020. We hope you will join us for this learning collaborative.
Clinical Practice Guidelines
Partners regularly reviews and adopts evidence-based Clinical Practice Guidelines developed by recognized sources such as:
- Journal of the American Academy of Child and Adolescent Psychiatry
- Centers for Disease Control and Prevention (CDC) Guidelines
- American Psychiatric Association (APA)
The guidelines are adopted for the most relevant behavioral health conditions identified by Partners. These guidelines are monitored, reviewed and approved by Partners’ Clinical Advisory Committee at least every two years or sooner if needed. Partners has chosen to focus on the following guidelines in 2020. No action is needed by providers.
- Child/Adolescent Clinical Practice Guideline: AACAP – Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder (2007) https://www.jaacap.org/article/S0890-8567(09)62182-1/fulltext
- Medication Information (Adult, Opioids) Clinical Practice Guideline: CDC Guideline for Prescribing Opioids for Chronic Pain (2016) https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
- Adult Mental Health Clinical Practice Guideline (Adult, Depression): APA-Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition (2010) https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
If you have questions, please contact Deborah Sprinkle at firstname.lastname@example.org.
Providers are reminded to use the email email@example.com for all email inquiries so questions and inquiries are handled in the most efficient manner. Please do not send emails directly to individual employees.
Explanation of Benefits Requests for Coordination of Benefits Claims: As a reminder, Partners requests copies of the Explanation of Benefits for members/claims submitted indicating Coordination of Benefits. The request will originate via an email from Partners’ Claims Department staff. Once requested, please submit the information, via a secured email, prior to the date indicated in the emailed request. If a response is not received, the original claim payment will be recouped.
Taxonomy Code 193200000X: Taxonomy Code 193200000X should not be submitted on claims as the rendering taxonomy code. All claims submitted with this taxonomy code as the rendering code will be reverted.
|December 2019: Medicaid—Number of Days to Process and Pay All Claims|
|Received Date to Paid Date:||10.1|
|Top Five Medicaid Claim Denials for December 2019|
|Claim Denial||Provider Recommended Action Steps|
|Service is not authorized||Verify Service Authorization for the consumer. Contact Utilization Management.|
|No coverage available for Patient/Service/Provider combo
|Go to Patient -> Patient Search and search for the patient in question. Check the insurance to ensure the patient has effective insurance covering to date of service submitted on the claim. If this appears to be correct, contact the MCO for further assistance.|
|Duplicate Claim||The claim has previously been submitted and adjudicated. Do not refile.|
|Billing Taxonomy submitted is not associated with billing NPI.||Rebill claim with correct taxonomy/NPI information.|
|Claim received after billing period.||Write off charges as non-billable. Do not rebill.|
Medicaid Managed Care: Providers are reminded to visit https://medicaid.ncdhhs.gov/ for the most up-to-date information about NC DHHS’ plans regarding Medicaid Managed Care. At this time, beneficiaries will continue to get physical and behavioral health services as they do now. They do not need to choose a health plan.
DHHS continues to work to launch the Behavioral Health and Intellectual/Developmental Disability Tailored Plan in 2021. This plan is designed for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DD). The Behavioral Health I/DD Tailored Plan will also serve other special populations, including Innovations and Traumatic Brain Injury (TBI) waiver enrollees and waitlist members. Providers are reminded to visit https://medicaid.ncdhhs.gov/providers/programs-and-services/behavioral-health-idd-tailored-plan for the most up-to-date information regarding Tailored Plan transition.
Bundled Rate Payment Model Pilot for Medication Assisted Recovery: The Division of Mental Health, Developmental Disabilities and Substance Abuse Services has issued a Request for Applications for Bundled Rate Payment Model Pilot for Medication Assisted Recovery. The due date for applications is February 17, 2020. To learn more, visit https://www.ncdhhs.gov/about/grant-opportunities/mental-health-developmental-disabilities-substance-abuse-services-grant-opportunities.
Upcoming NC DHHS Events and Webinars
State-funded Services Design Under Behavioral Health I/DD Tailored Plans Webinar (Registration)
Date and Time: Friday, January 24, 2020, from 10 a.m.-11 a.m.
Description: This webinar will walk stakeholders through aspects of State-funded Services design under Behavioral Health I/DD Tailored Plans detailed in the recently released “North Carolina’s Design for State-funded Services Under Behavioral Health and Intellectual/Developmental Disability Tailored Plans,” including the delivery of State-funded behavioral health, I/DD, and TBI services, as well as the continuation of critical “local health functions” (functions focused on health prevention and promotion) under Behavioral Health I/DD Tailored Plans.
NCDHHS Supported Living Level 3 Stakeholders Meeting
Date, Time, and Location: January 30, 2020, 1 p.m.-3 p.m., Alliance Health, Magnolia/Dogwood Room, 5200 W. Paramount Pkwy, Suite 200, Morrisville, NC 27560
Stakeholders can participate by:
- Attending in person
- Via webinar: https://zoom.us./j/555051513
- Call in by dialing 1-646-558-8656 and enter access code 555051513#
NC DHHS Town Hall Meetings with Kody Kinsley, Deputy Secretary, Behavioral Health and Intellectual and Developmental Disabilities
Dates, Times and Locations:
- January 30, 2020, 12:30 p.m.-2:30 p.m., First Baptist Church Activity Center, 1939 Independence Blvd., Wilmington, NC
- February 20, 2020, 12 p.m.-2 p.m., Green Tree Peer Center, 930 S. Broad St., Winston-Salem, NC
Description: NC’s public Behavioral Health and Intellectual and Developmental Disabilities (I/DD) System is undergoing major changes. We want to hear from our consumers, families and advocates about how the system is working and how we can assist in creating a system that improves health outcomes and promotes recovery for all North Carolinians.
Registration is recommended but not required to attend the Town Hall. Register at bit.ly/BH-IDD-town-halls.
Joint Communication Bulletins, which are issued by the NC Department of Health and Human Services, can be found at https://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins.
- December 19, 2019: #J351 Payment for Interpreter Services
- December 20, 2019: #J352 Network Adequacy and Accessibility Analysis Requirements for NC LME-MCOs
- Network Adequacy and Accessibility Analysis Requirements 2020
- Appendix A – DMHDDSAS Contract Language
- Appendix B – NC Medicaid Contract Language
- Appendix C – Service Codes
- Appendix D – Urban & Rural County Designation
- Appendix E – Form To Request Exception_Choice_Access
- Appendix F – Network Access Plan Requirements_2020
January 7, 2020: #J353 State-Funded Behavioral Health Urgent Care service definition
Partners Training Academy
All Partners Training Academy sessions are free to registered attendees. Register in advance at www.PartnersTraining.org. If you have any questions about Partners Training Academy events, please email Training@PartnersBHM.org.
Permanent Supportive Housing (PSH) Training
Date, Time and Location: January 21 and 22, 2020, 8 a.m.-5 p.m., Hickory (Registration)
Description: This training will focus on the evidence-based model for Permanent Supportive Housing (PSH). This training will support Community Support Team providers by improving their understanding and practice of the PSH model.
Target Audience: Community Support Team providers
Provider Open House
Date, Time and Location: Thursday, February 6, 2020, 9:00 a.m.–12:00 a.m., Gastonia (Registration)
Description: Join Partners’ Provider Network, Claims, Access to Care, Utilization Management, Care Management and Quality Management staff for an interactive information session. This open-house style event will allow each attendee to work one-on-one with Partners’ staff to discuss any issues, questions, or unfamiliar topics. Participants are encouraged to bring their own laptops to access their specific workflow.
These sessions will not have a formal presentation or start time. This is a time where providers can meet one-on-one with Partners’ staff for technical assistance. As a registered attendee, you are welcome to arrive and exit at your convenience, depending on the amount of time you feel is needed with our staff. Providers who are new in the Partners’ network are advised to already have established access to AlphaMCS and reviewed the provider orientation toolkit prior to attending a session.
Target Audience: New and established providers in Partners’ provider network.
Community Support Team (CST) Service Definition Training
Date, Time, Location: February 6, 2020, 9 a.m.-12 p.m. Webinar (Registration)
Description: The subject of this webinar is the new CST service definition. The webinar will include an overview of the CST service definition, a brief overview of Permanent Supportive Housing (PSH) evidenced-based model, and a focus on utilization management requirements to authorize services. The webinar will meet the three-hour service definition training requirement.
Target Audience: CST providers and direct support staff
Trainer: Partners Utilization Management
Licensed Independent Practitioner Collaborative (LIP) Collaborative
Date, Time, Location: February 12, 2020, 12 p.m.-1 p.m. (Webinar) (Registration)
Description: The Licensed Independent Practitioner (LIP) collaborative was developed to improve communication between Partners and Licensed Independent Practitioners. Meetings are held quarterly via conference call or webinar.
Target Audience: In-Network Licensed Independent Practitioners
Trainer: Michelle Stroebel, MA, NCC, LPCA
Provider Alerts are sent to all providers who subscribed to receive Partners’ Provider Communications. Published alerts are available on the Provider Knowledge Base at https://providers.partnersbhm.org/provider-alert-archive/. To subscribe to Partners’ various communications, please visit https://www.partnersbhm.org/subscribe/.
Alerts issued since the last Provider Bulletin:
December 20, 2019 – Changes to OUD Treatment Payment | JCB #351-Interpreter Service Payment
January 7, 2020 – ROI Deadline Extended | State-funded Service White Paper | Training
Partnership Honored by i2i for Community Inclusion Efforts
Partners, McLeod Center, Addiction Recovery Medical Services, Olive Branch Ministry, PQA Healthcare, and Catawba Valley Behavioral Health were recognized by the i2i Center for Integrative Health for their efforts to enhance the focus on opioid recovery during i2i’s annual conference.
The organizations have worked together since January 2018 to enhance the focus on opioid recovery by adding Certified Peer Support Specialists (CPSS) to opioid treatment programs (OTP) in Partners’ catchment area. In March 2019, a comprehensive specialized training program was created by the five organizations to provide six Community Peer Support Specialists to educate individuals receiving opioid treatment about Medication Assisted Recovery and the Outpatient Program treatment model. These employees work daily in the opioid treatment programs as role models, engagement specialists and resource experts.
In addition, the Certified Peer Support Specialists identified many members who struggled to participate in community support groups such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA). They responded to concerns from individuals receiving services in opioid treatment programs by starting a nontraditional 12-step program where participants would feel accepted. The Certified Peer Support Specialists worked together to start Medication Assisted Recovery Anonymous (MARA) support groups in each clinic (https://www.mara-international.org/).
Five community organizations, including Partners, received the i2i Community Inclusion Innovation Award at its annual conference in Pinehurst. Pictured are (L-R) Mary Hooper, i2i Center for Integrative Health; Tiffany Randazza, McLeod Center; Tim Lentz, Catawba Valley Behavioral Healthcare; Khalil Nassar, PQA; and Barbara Hallisey, Partners. Olive Branch Ministry was also honored.
These groups initially began as a collaboration of peers who were connected via a conference call at a designated time each week. Support for the MARA groups grew at each site to the point that the initial group had enough participants for each site to have its own MARA support group. Hosting the MARA groups within the opioid treatment programs gives individuals who are participating in opioid treatment an opportunity to connect with peers and offers hope and inspiration in a nonjudgmental environment. Building community capacity, and thus inclusion for this alternative support group, continues to create safe and welcoming spaces for individuals using medications to assist with recovery.
MARA groups are currently available in Catawba, Iredell and Lincoln counties. To learn more, visit https://www.mara-international.org.
Training, Announcements and Reminders
Recovery Coach Academy: The Recovery Coach Academy is a 30-hour training on the Recovery Coach model. It is approved for continuing education credits by NCSAPPB and the CPSS board and is open to people in long-term recovery. The training will be held Monday, January 27 through Friday, January 31 at Surry Community College, 1461 North Bridge Street, Elkin, NC. Registration is required. To learn more about Recovery Coach Academy or to register, please contact Elisa Bryant at 336-526-1918 or email firstname.lastname@example.org. This training is possible through a grant from Recovery Communities of NC (funded by NC DHHS and SAMHSA).
RESCHEDULED Connect Burke: The next Connect Burke resource forum will be held on Tuesday, February 11 beginning at 8 a.m. at the Collett Street Recreation Center, 300 Collett Street, Morganton, NC 28655. This forum will focus on housing and homelessness issues and will include numerous agencies that offer services, programs, and ways to connect to those we serve. Click here to register. To learn more, contact Jamie Piercy at email@example.com.
Person-Centered Thinking: Benchmarks NC will host Person-Centered Thinking training February 26 and 27, 2020 at The Arc of North Carolina, 353 East Six Forks Rd., Suite 300, Raleigh, NC. The cost for Benchmarks members is $108; cost for non-members is $120. To learn more or register, click here.
11th Annual NC ‘One Community in Recovery’ Conference: The NC ‘One Community in Recovery’ Conference is an inspiring and informative event, designed to foster the continuing growth of the North Carolina Recovery Movement, to teach participants how to get recovery programming up and running in their own communities, to showcase some of the most progressive recovery practices and to bring the community of providers and individuals in recovery together as students and partners. This conference is also designed to educate and motivate participants to apply principles of recovery in their personal and professional lives.
The conference will be held March 11-13, 2020, at the Wyndham Garden Greensboro, 415 S. Swing Rd., Greensboro, NC 27409. For more details, to download the event brochure, or to register, please click here.
The Arc of North Carolina’s Rooted in Advocacy Conference will take place on March 13, 2020, at the Benton Convention Center in Winston-Salem, NC. To learn more about this event or to register, please visit https://www.rootedinadvocacy.org/.
NC Tide Spring Conference: Registration is now open for NC TIDE’s Spring conference, being held April 19-22, 2020 at the Hotel Ballast, Wilmington, NC. To learn more, visit http://nctide.org/. Early bird rate ends April 1, 2020.
NC TIDE Seeks Nominees for the Empowering Hope Award: NC TIDE is encouraging behavioral health organizations to nominate one of their members for its Empowering Hope award. If you feel you have a member who would qualify and would like to be recognized, please complete the application and submit to the contact person noted on the application by March 1, 2020.
The member identified as the 2020 recipient will be recognized at the NC TIDE 2020 Conference in Wilmington, NC (April 19-22, 2020) at the Hotel Ballast. To learn more about the NC TIDE 2020 Conference, visit nctide.org.