Annual Submission of Provider Quality Improvement Projects
This is a reminder of Partners’ expectation for providers/contractors that deliver Medicaid and/or State-Funded services to submit three quality improvement projects (QIPs) by August 31, 2020. (Licensed Independent Practitioners are excluded from this requirement.)
Providers will submit their QIPs to Partners via ShareFile. Most providers have already shared their representative’s contact information for ShareFile and may have already received the email with instructions to create a password for uploading QIPs. If you still have access to the ShareFile log-in you used last year, please use it to upload your QIPs by August 31, 2020.
If you have previously used a ShareFile login for this purpose but cannot access the login information or need to associate the login with a different staff member within your organization:
- Send an email with the provider name and new staff information (email contact number) to firstname.lastname@example.org.
- The new staff member will be sent an email from ShareFile with instructions on how to set up a password to allow the upload of the QI projects
If you do not have access to ShareFile to upload the QIPs, then:
- Identify your organization’s contact person [preferably staff that is responsible for QI activity] and email their name, telephone number and email address to Tamikka Woods (Twoods@partnersbhm.org). If your staff contact changes at any time, you will need to submit updates in the same manner.
- The contact person in your organization will receive an email from Partners’ ShareFile system.
- Follow the instructions in the ShareFile email to create a password. Upload three Quality Improvement Projects by August 31, 2020 [No specific topics are required at this point].
- Every year by the last business day of August [the next deadline will be August 31, 2020], until further notice, the expectation is for providers to submit three Quality Improvement Projects in this manner.
If you have further questions, please contact Tamikka Woods by calling 704-884-2568 or email email@example.com.
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.
As you fine-tune your after-hour coverage policies and procedures, consider the member perspective in ensuring the easiest access to your crisis staff. How do they know what number to call if they are not near their home? Is your crisis number listed on your voicemail? 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/SU 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/SU 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.
- This contact may not be:
- Sample script for voice mail messages for after-hours coverage:
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.
Finding help for our shared members just got easier! On July 1, 2020, Partners launched PartnersLink, an online platform that helps connect people in need to resources and social programs across the United States. PartnersLink makes it easy for people facing social needs – and those who help others – to find and make referrals to appropriate programs and services for food, shelter, health care, work, financial assistance and more.
Try it out by visiting https://partnerslink.auntbertha.com/, and make sure to create an account for access to free tools and features.
State News/COVID-19 Updates
Providers are reminded to check Partners’ COVID-19 provider webpage and the NC DHHS COVID-19 Guidance and Resources for Medicaid Providers for the most up-to-date information. If you have questions, please email your provider account specialist or the Provider Network Help Desk at firstname.lastname@example.org.
Medicaid Bulletins: All bulletin articles, including those related to COVID-19, are available on the DHB webpage.
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.
Recent Joint Communication Bulletins:
June 18, 2020: #JCB367 – I/DD Supported Employment Guidance Update
July 6, 2020: #JCB368- Compliance with Alternatives and Restrictive Intervention – Re-Certification and Initial Certification-Training Requirements and CPR and First Aid Training Requirements During the COVID-19 Pandemic
Joint DMHDDSAS and DHB (NC Medicaid) COVID-19 Update Call For BH/IDD Consumers, Family Members and Community Stakeholders:
Every Monday at 2:00 p.m., check the Partners COVID-19 Provider webpage for weekly call-in details.
Joint DMHDDSAS and DHB (NC Medicaid) COVID-19 Update Call for NC Providers:
Every Thursday at 3:00 p.m., check the Partners COVID-19 Provider webpage for weekly call-in details.
Providers are reminded to use the email email@example.com for all email inquiries so that they are handled in the most efficient manner. Please do not send email directly to individual employees.
ATTENTION PROVIDERS – Claims Processing Information
Beginning July 1, 2020, the authorization edit was enabled. This means that:
- Any claims submitted after June 30, 2020, will deny if there is no authorization and an authorization is required for the procedure code.
- Claims dated March 19, 2020-June 30, 2020 will be manually processed/approved if the claims deny for no authorization only.
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.
Explanation of Benefits Requests for Coordination of Benefits Claims: As a reminder, Partners does request copies of the Explanation of Benefits (EOB) for members/claims submitted indicating Coordination of Benefits. The request will originate via email from Partners’ Claims Department. Once requested, please submit the information, via secured email, prior to the date indicated in the emailed request. If a response is not received, the original claim payment will be recouped.
|June 2020: Medicaid—Number of Days to Process and Pay All Claims|
|Received Date to Paid Date:||8.4|
Top Five Medicaid Claim Denials for June 2020
Provider Recommended Action Steps
|Duplicate Claim||The claim has previously been submitted and adjudicated. Do not refile.|
|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.|
|Claim received after billing period.||Write-off charges as non-billable. Do not rebill.|
|Client has other covered insurance (COB)||Ensure the primary insurance for the patient has been billed and is indicated on the claim being submitted to the MCO.|
|Weekly frequency exceeded||Limit to occurrence of service billable per week. If necessary, submit a SAR for service authorization. Adjust off and do not refile. Only if service is billed in error, submit a replacement claim.|
CMS Issues Home and Community-Based Settings Regulation
On July 14, the Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid agencies informing them that the agency will be extending the deadline for ensuring compliance with the Home and Community-Based Settings Regulation, in response to the COVID-19 pandemic. CMS recognizes that states have faced significant challenges and delays in their implementation activities, and that service provision and community integration approaches have been disrupted.
Due to these unprecedented challenges, CMS has extended the compliance deadline for this regulation to March 17, 2023. CMS is committed to continuing its work with states, advocates, and other stakeholders to continue to improve HCBS options. Technical assistance and support for states remain available during the extension period to ensure meaningful progress with ongoing implementation efforts.
Provider Information Sessions/Partners Provider Council
Partners will continue to host Provider Information Sessions in August. To register for a session, click on the date and time listed below. You may submit your questions to firstname.lastname@example.org in advance; we also recommend that you review the FAQs from past information sessions.
- July 23, 2 p.m., Mental Health and Substance Use Disorder
- August 5, 1:30 p.m., Innovations/IDD
- August 11, 3 p.m., Mental Health and Substance Use Disorder
The Partners Provider Council will not meet in July. The next meeting will be held on August 28, 2020 at 9:30 a.m. Click here to register.
Training for Providers
IRIS Overview/Training (Register)
Date, Time, Location: July 29, 2020, 1 p.m. – 1:30 p.m., Recorded Webinar
Description: Join us for an overview of the Incident Response Improvement System. Define incidents and determine responses to various levels. Clarify reporting responsibilities. Review key report functions and web submission tips.
Target Audience: Providers who use IRIS
Trainer: Partners’ Consumer Rights Officers
Cognitive Behavioral Therapy (CBT) Foundations Virtual Training (Register)
Date, Time, Location: July 30 and July 31, 2020, 9:30 a.m. – 12:45 p.m., Online
Description: Cognitive Behavioral Therapy (CBT) is an evidence-based practice that focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and developing personal coping strategies that target solving current problems. Training will take place over two days, July 30 and July 31 from 9:30 a.m. – 12:45 p.m. on both days, utilizing the same training link. Participants will have to be present with audio and visual capabilities for both sessions to receive credit. No partial credit will be given.
NCSAPPB approval code 20-453-S up to 6 hours
Target Audience: Partners Network Providers
Trainer: Eric Ottinger Recovery Rebel Revolution LLC
Person Centered Thinking – 12-hour Virtual Class (Register)
Date, Time, Location: August 3 – 4, 2020 8:30 a.m. – 4:00 p.m., Online
Description: Person Centered Thinking (PCT) is a foundation and philosophical framework for those involved in supporting people with disabilities. This activity-filled, two-day training consists of applied stories, guided exercises, group work and discussion. This approved National Learning Community Curriculum meets the requirements of NC service definitions. This is a virtual live event; all participants will be required to have audio and visual capabilities for the full two days. You will receive a Learning Community Certificate for completing the class. No partial credit will be given. This class meets the required 12-hour Person Centered Thinking requirement for NC.
Target Audience: Partners Network Providers
Trainer: The Learning Community Trainers
Provider Open House (Register)
Date, Time, Location: August 4, 2020, 9 a.m. – 11 a.m., Online
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 time to work one-on-one with Partners’ staff to discuss any issues, questions or unfamiliar topics.
For this session, we will be using Zoom and breakout rooms. These sessions will not have a formal presentation or start time but is the providers’ time to meet one-on-one with Partners staff for technical assistance. Providers will need to register prior to the event. 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. The intended audience for the open house includes established and new providers in Partners’ network. Providers who are new to Partners’ network are advised to already have established access to AlphaMCS and reviewed the provider orientation toolkit prior to attending a session.
Target Audience: Existing and New Providers in the Partners Network.
NC-TOPPS Discussion (Register)
Date, Time, Location: August 5, 2020, 2:00 – 2:30 p.m., Online
Description: The purpose of the monthly NC-TOPPS Discussion Webinar is to provide a space for the attendees to receive updates, ask questions and provide feedback to the Partners NC-TOPPS superuser as well as other superusers. All are welcome, both new and existing users.
Target Audience: Providers who use NC-TOPPS
Trainer: Veronica Somerville, QM Analyst
Community Support Team Service Definition
Multiple Training Dates:
- August 18, 2020, 8:30 – 11:45 a.m., Recorded Webinar (Register)
- September 15, 2020, 12:30 – 3:45 p.m., Recorded Webinar (Register)
Description: This training meets the requirement for CST team members to receive three hours of service definition training. Attendees must take a 10 question quiz and pass at a rate of 80% or higher in order to gain a training certificate.
Target Audience: Providers delivering CST
Trainer: Partners Utilization Management
Licensed Independent Practitioner (LIP) Collaborative Webinar (Register)
Date, Time, Location: August 19, 2020, Noon – 1 p.m., Online
Description: The Licensed Independent Practitioner (LIP) collaborative was developed to improve communication between Partners and Licensed Independent Practitioners. Meetings are held quarterly via webinar.
Target Audience: In-Network Licensed Independent Practitioners
LIPs can view information from previous LIP Collaborative meetings at https://providers.partnersbhm.org/licensed-independent-practitioners-collab/.
Providing ASAM Informed Treatment
Save the date! Registration to be posted to the training calendar by August 1.
Two opportunities for training:
- August 25, 2020, 1 p.m. – 3:30 p.m., Recorded webinar
- August 26, 2020, 9 a.m. – 11:30 a.m., Recorded webinar
Description: This American Society of Addiction Medicine course meets service definition requirements for ASAM training. Participants will receive tools in the form of handouts and watch a pre-recorded webinar training. A certificate is offered once registrants pass a 10-question quiz. Course contents include the purpose of ASAM, an overview of ASAM changes and DSM5 changes, ASAM dimensions and level of care, clinical assessment and the application to treatment planning, level of care and risk assessments as well as informed treatment and medical necessity.
Target Audience: Providers who need initial training and/or a refresher.
Trainer: Partners’ Utilization Management Staff
Permanent Supportive Housing (PSH) Virtual Training Series (Register)
Dates and Times:
- September 15, 2020, 8:00 a.m. – 12:30 p.m.
- September 17, 2020, 8:00 a.m. – 12:30 p.m.
- September 22, 2020, 8:00 a.m. – 12:30 p.m.
- September 24, 2020, 8:00 a.m. – 12:30 p.m.
Attendees must be present for the entirety of all four sessions of this training to receive a certificate of completion.
Description: Partners has scheduled a series of virtual trainings on the evidence-based model for Permanent Supportive Housing (PSH). With the policy change, CST providers are to provide ongoing, tenancy support services. This training will support ANY provider by improving their understanding and practice of the PSH model. Experienced and certified PSH trainers from the Technical Assistance Collaborative (TAC) have created the training. These sessions will be facilitated by TAC trained Partners’ staff.
Other things to know:
- This is an interactive training. Attendees are expected to participate fully (audio and visual required).
- Attendees must be present for the entirety of all four sessions of this training to receive a certificate of completion. This is equal to the two-day, in-person class.
- If you arrive more than 15 minutes late, you will not receive credit.
- No partial credit will be awarded.
Target Audience: All employees who deliver CST (15 hours of Tenancy Support Training must be completed within 90 days of hire. This training meets that requirement), ACTT, TCLI, and any housing staff.
Trainer: Partners Provider Network Trainers
Other training resources and opportunities
Resource for ACT and IPS Trainings: The Institute for Best Practices, UNC Chapel Hill, www.institutebestpractices.org.
Improving Cultural Competency for Behavioral Health Professionals (Online)
Date, Time, Location: This training is a self-study from the Office of Minority Health website. FREE CEU’s
Description: Cultural and linguistic competency is recognized as an important strategy for improving the quality of care provided to clients from diverse backgrounds. The goal of this e-learning program is to help behavioral health professionals increase their cultural and linguistic competency.
- In Course 1, An introduction to cultural and linguistic competency, you’ll learn what culture has to do with behavioral health care.
- In Course 2, Know thyself – Increasing self-awareness, you’ll learn how to get to know your cultural identity and how it affects your work with clients.
- In Course 3, Knowing others – Increasing awareness of your client’s cultural identity, you’ll learn how to get to know your client’s cultural identity.
- In Course 4, Culturally and linguistically appropriate interventions and services, you’ll learn how to build stronger therapeutic relationships with clients from diverse backgrounds.
The estimated time to complete all four courses is between 4 – 5.5 hours.
Target Audience: This program is accredited for 4 – 5.5 contact hours for counselors, nurses, psychologists, psychiatrists and social workers. Other professionals may earn a Statement of Participation.
Resources to Improve Business Acumen:
SCORE is a resource partner of the U.S. Small Business Association and has been in existence since 1964. (https://www.score.org/)
SCORE offers a variety of training courses for a low cost or for free. In addition to training, they offer volunteer counselors, advisors and mentors who offer individual, free to low cost counseling throughout the US. They have many online courses that are free on many topics related to running and growing your business. (https://www.score.org/courses-demand?page=2)
The Small Business Development Center offers local business consulting and at-cost training on a variety of business-related topics at https://americassbdc.org/small-business-consulting-and-training/find-your-sbdc/.
There are SBDCs in Charlotte, Hickory, Boone, Winston-Salem, Greenville, Asheville and many other locations across the state.
Human Trafficking During Quarantine (Register)
Date, Time, Location: July 23, 2020, 1:00 p.m. – 3:00 p.m., Online
Description: Many of us are working from home and our children may be at home as well. Many children may be online more with less supervision than usual. Learn about human trafficking and how to keep our children safe.
Trainer: Jeanne Patterson, Partners
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/.
June 26, 2020: COVID-19 #28 – Eligibility & Enrollment Deadlines
July 1, 2020: COVID-19 #29 – Utilization Management Update for COVID-19 Flexibilities Update
July 10, 2020: COVID-19 #30 – Temporary Rate Increases
Training, Announcements and Reminders
The following events are being held by various organizations. Please check with the organization hosting the event regarding registration and cancellation information.
Hurricane Season and COVID-19: How Families of Children and Youth with Special Health Care Needs Can Be Prepared: Hurricane season will be different this year as North Carolina continues to take precautions to slow the spread of COVID-19. This webinar series addresses the most pressing topics and questions related to how individual preparedness, hurricane response and recovery will be different due to COVID-19. Family members, caregivers, disability organizations and emergency preparedness professionals are encouraged to attend these sessions to help understand how to meet the needs of children and youth with special health care needs and those with disabilities in the event of a hurricane.
How State and Local Officials are Preparing during COVID-19
Wednesday, July 22 at 11 a.m. (Register)
- Sandi Bridges, Human Services Branch Manager, NC Emergency Management
- Kellie Currie, Access and Functional Needs Specialist, Brunswick County, Emergency Management
- Kent Greene, Iredell County Emergency Management
- Keith Acree, Public Information Officer, NC Emergency Management
- Gwen Bartley, Children and Youth Branch Family Partner
Recovery, Resources, and Questions Answered about Preparing during COVID-19
Wednesday, July 29 at 11 a.m. (Register)
- Brenda Morris, Recovery Grants Manager, NC Emergency Management
- Sheri Badger, Disability Integration Specialist, NC Emergency Management
- David Musick, NC FEMA Integration Team Lead, FEMA
- Tocarra Osborne, Children and Youth Branch Family Partner
- Gwen Bartley, Children and Youth Branch Family Partner
The webinars are hosted by North Carolina Emergency Management and the North Carolina Office on Disability and Health, NC Division of Public Health, Children and Youth Branch. Please direct any questions to Lauren.Howard@dhhs.nc.gov
Autism and Covid-19: Teaching the rules in this new norm:
This free webinar, being held on July 23 from 11:30 a.m.- 1 p.m., is geared towards families and professionals who are working to support individuals with ASD/IDD in understanding and adhering to health precautions and safety rules (temperature screenings, wearing a facial covering, waiting six feet apart from others, and washing hands frequently) that they might encounter in community settings, programs, camps and school settings during this pandemic. Guidance and support tips will also address the potential need for COVID-19 testing and recommendations based on testing results. The webinar will offer practical, autism-informed strategies and key considerations. Opportunities for Q&A/discussion will be featured as well.
A to Zs of COVID-19 for Families and Individuals with I/DD:
The i2i Center, as part of the Cross-System Navigation grant from the NC Council on Developmental Disabilities, will be hosting A to Zs of COVID-19 for Families and Individuals with I/DD on July 29, 2020 from noon – 1:00 p.m.
This free webinar is targeted to individuals and family members with I/DD and will offer information on:
- Personal health and care needs during COVID-19.
- What you need to know if you or a family member is hospitalized with COVID-19.
- Understanding your rights when visiting family members residing in congregate care settings.
- What to do if you are choosing to keep your child or family member at home and not receiving services.
Free Virtual Training from Rebound Behavioral Health:
Rebound Behavioral Health is offering FREE virtual trainings with CEUs. A complete list of trainings, dates and times can be found on Rebound Behavioral Health’s events page. All trainings are approved by the NCSAPPB and cover topics such as DBT, Trauma, ACT, Twelve Step Facilitation and Illness Management and Recovery. Each training counts as three CEU Credits and will be for a duration of three hours
NC Providers Council Conference Postponed:
After careful consideration, the North Carolina Providers Council Board has decided to postpone the September 2020 conference. As the uncertainty around the pandemic’s trajectory and the safety of mass gatherings continues to affect plans, the Providers Council will monitor federal and state government guidance to determine the best timing. The Providers Council plans to reschedule in 2021 and keep Providers Council members and interested parties updated. If you have already committed to be an exhibitor or sponsor or registered to attend, someone will contact you to discuss credit and refund options.
The Providers Council will continue to incorporate virtual meeting venues throughout the year until we can enjoy opportunities for in-person networking at the 2021 conference. In the interim, you are encouraged to sign up for or continue to join standing committee meetings to stay connected with fellow NCPC members and to engage in conversations about policy and operational issues that the Providers Council can address with the LME/MCOs, DHHS Divisions, and General Assembly Members.