Holiday and Inclement Weather Appointment Scheduling
Providers offering appointments through the AlphaMCS Slot Scheduler need to ensure that appointments through the rest of December and January are scheduled correctly. Please make sure that your appointments account for the:
- Correct operating hours over the holidays
- Type of funding and clients served (Medicaid or State)
Providers are also asked to upload appointments for the next month at least two weeks prior to the beginning of the month. In addition, please contact Access to Care if your office or site is closing for inclement weather. This will assist us to best serve customers. If you have any questions, please contact Access to Care at 1-888-235-4673.
Inclement Weather Reminders
Partners will announce any additional inclement weather closing information on our website, www.partnersbhm.org and our Facebook page.
Please remember that:
- Access to Care is available 24 hours a day, seven days a week, at 1-888-235-HOPE (4673).
- Our Utilization Management Hospital Admissions Team is available from
8 a.m.-9 p.m., seven days a week, at 704-842-6434.
- The Partners Training Academy uses the following guidelines for inclement weather:
- If training is scheduled at the Gastonia location and school is delayed or cancelled in Gaston County, training will be cancelled and rescheduled.
- If training is scheduled at the Hickory location and school is delayed or cancelled in Catawba County, training will be cancelled and rescheduled.
- If training is scheduled at the Elkin location and school is delayed or cancelled in Surry County, training will be cancelled and rescheduled.
DHHS Review Tool for LIPs/Group Practices and Agencies Billing Outpatient Services Only Updated
In follow up to LME-MCO Communication #J292, Changes to DHHS LIP/Agency Practice Provider Monitoring Review Process, this communication is to advise that, following continued collaborative efforts and assessment of the Monitoring Process with Practitioners and the PAC (Professional Association Council), the DHHS Review Tool for LIPs/Group Practices and Agencies Billing Outpatient Services Only (BH) were updated (Guidelines and Overview revised effective Nov. 30, 2018), and are posted to the NC Department of Health and Human Services (DHHS) website. These revisions are a continued commitment on behalf of DHHS, PAC, Licensed Independent Practitioners (LIPs), Group LIP Practices and the LME-MCOs to improve and streamline the monitoring process. The changes are effective Dec. 10, 2018.
The update in the process does not diminish or reduce the LME-MCO’s responsibility/authority for oversight and monitoring of their Provider Networks. If you have questions, please contact Larry Holcombe, Quality Management Monitoring Manager, at firstname.lastname@example.org or 704-884-2528.
NCTRACKS List of Providers Due for Re-verification Jan – June 2019 Now Available
A list of providers scheduled for re-verification between January and June 2019 is available on the under Quick Links. Providers can use this resource to determine their re-verification due date and which month to begin the re-verification process. Organizations and systems with multiple providers may download this list, which includes National Provider Identifier (NPI) numbers and provider names, to compare with their provider list.
Autism Services Learning Collaborative
Partners is introducing an Autism Services Learning Collaborative as an opportunity for providers of Adaptive Behavioral Treatment / Research Based- Behavioral Health Treatment (ABT/RB-BHT) and Partners’ employees to meet periodically as we work to expand the continuum of care available to children diagnosed with Autism.
Date, Time and Location: Tuesday Jan. 29 10 a.m.-12 p.m., Partners Gastonia-New Hope Office, 901 S. New Hope Rd., Gastonia, NC 28054
Goals of this collaborative:
- To expand the use of Evidence Based Practices for children diagnosed with Autism in order to promote positive outcomes.
- To identify and reduce barriers to treatment
- To collaborate with other providers across the entire Partners System of Care
- To explore how Partners can better support you
Who should attend? Adaptive Behavioral Treatment Providers, RB-BHT Providers, Clinical Directors/Supervisors, Board Certified Behavior Analysts, Quality Management staff. Representation from all of our ABT/RB-BHT service providers will ensure the success of this collaborative, so we hope to see you there!
Employees from Partners Care Coordination, Provider Network, System of Care and Utilization Management departments will also be in attendance.
Please RSVP and send any questions to Sara Wilson at email@example.com.
Integrated Care Survey
The Partners Integrated Care team works to promote the value the of addressing physical health needs, behavioral health needs and the social determinant of health needs in delivering care. We are looking this year to highlight what our network providers do to coordinate care with their consumers’ primary care physicians. Please complete the included survey to help us start the process in identifying our providers’ efforts.
Providers are reminded to use the email firstname.lastname@example.org for all email inquiries so that they are handled in the most efficient manner. Please do not send email directly to individual employees.
Timely Filing Override Requests: Please make sure claims are being submitted according to the timely filing guidelines available at https://providers.partnersbhm.org/claims-information/. If claims deny for any of the reasons below, make sure you submit timely filing override requests within the time frames. Timely Filing Requests should be sent directly to email@example.com prior to submitting the claims.
|Medicaid—November 2018: Number of Days to Process and Pay All Claims|
|Received Date to Paid Date:||8.9|
|Top Five Medicaid Claim Denials—November 2018|
Provider Recommended Action Steps
|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.|
|Service is not authorized||Verify Service Authorization for consumer. Contact Utilization Management.|
|Claim received after the billing period||Write off charges as non-billable. Do not rebill.|
|Claim has previously been submitted and adjudicated. Do not refile.|
|Billing Taxonomy submitted is not associated with the Billing NPI||Rebill claim with a valid taxonomy/NPI information.|
Claims Accuracy and Timeliness Audit Results: Partners Behavioral Health Management recently received the results of the Claims Accuracy and Timeliness Audit performed on behalf of North Carolina Department of Health and Human Services, Division of Medical Assistance prepared by HMS.
|Claims Accuracy and Timeliness Audit: Summary Findings|
|Timeliness of Provider Payments (within 30 days)||99.96%||Compliant|
|Claims Processing Accuracy||99.98%||Compliant|
The results of the audit are statistically valid and can be extrapolated across the entire population of claims. The random audit can identify systemic processing errors, if they exist, within the sample. The random audit accomplishes the objective related to compliance and due diligence. In researching, Partners found that the claims identified were processed and paid correctly based on Alpha system edits.
Benefit Grid Updates
The following benefit grids have been updated effective Nov. 1, 2018:
- Medicaid Adult Mental Health/Substance Use Services Benefit Plan
- Medicaid Child Mental Health/Substance Use Services Benefit Plan
- Medicaid Adult and Child B3 Services Benefit Plan
- Medicaid Inpatient Services Benefit Plan
- State Adult Mental Health/Substance Use Services Benefit Plan
- State Child Mental Health/Substance Use Services Benefit Plan
- State Inpatient Services Benefit Plan
The benefit grids are located at https://providers.partnersbhm.org/benefit-grids/.
Don’t Let Improper Use of that NPI Land You in Hot Water
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires HIPAA covered health care providers to use the National Provider Identifier (NPI). Health care providers include individuals, such as physicians, clinical workers, psychologists, psychiatrists, pharmacists, and organizations such as hospitals, nursing homes, group homes, pharmacies, and group practices. Since May 2007, Medicaid, private health insurance issuers, and all health care clearinghouses must accept and use NPls in standard transactions, including electronic claims. Pursuant to HIPAA, covered providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.
Did you know that if a covered health care provider is rendering services on your behalf, you must indicate that provider as the rendering provider when you bill for those services? In other words, you cannot use your own NPI as the rendering provider when billing services provided by another covered health care provider. Conversely, you cannot use someone else’s NPI if they did not provide the service. Billing services that you provided using someone else’s NPI or allowing someone to use your NPI for services you did not render can get you in hot water!
In November 2018, the U.S. Attorney’s Office for the District of South Carolina announced a $200,000 civil settlement with Vital Energy Occupational Therapy and Wellness Center, LLC for allegedly knowingly submitting false claims to Medicare and Medicaid for physical and occupational therapy services. A qui tam whistleblower brought to the government’s attention an allegation, among others, that for a 3-year period ending in 2016, Vital submitted bills for therapy services using former employees’ names and NPIs when those employees did not actually provide the services. The whistleblower will receive $36,000 from the settlement.
In another Federal case out of Oklahoma, the government reached an agreement with Dr. Gordon Laid to pay $580,000 to settle False Claims Act allegations. Dr. Laid is the former owner and employee of several different health care businesses. Dr. Laid is alleged to have allowed one of the companies to use his NPI to bill Medicare for evaluations and physical therapy services that he did not provide or supervise.
Being aware of your responsibilities for billing and documenting services is important to the integrity of services provided. Just as it is everyone’s duty to be good stewards of public health care funds we are responsible for administering and being able to identify and report any suspicion of Fraud or Abuse. Our Code of Conduct/Ethics Agreement requires all Partners employees, contract providers and board/committee members to report any unethical activity, fraud or abuse.
If you think you have observed fraud or abuse, contact a Partners Program Integrity team member. You may also call the Alert Line at 1-866-806-8777, where a live person can assist you, or report fraud, waste or abuse online at https://partnersbhm.alertline.com.
- Code of Federal Regulations 45 CFR 162.410(a)(5)
Prepare for the Cold: Energy Tips for Consumers
Our recent snowstorm reminded us all that winter can get brutally cold and it’s just beginning. With nine more weeks of winter, now is an important time to remind your consumers of the importance of saving energy and reducing costs to their home. Energy bills in the winter can become high and can stretch the limits of any budget. Now would be a great time to remind consumers of the following tips to help try to reduce those costs:
- Reduce the thermostat to the lowest comfortable setting while home and turn it down a few degrees before leaving. According to Duke Energy, you will save approximately one percent of your bill for every one degree that you lower your thermostat.
- One of the easiest ways to help your HVAC system, is to regularly change your air filter in your home.
- Operate the ceiling fans in the home in a clockwise direction, which pushes warm air back down in the room.
- Leave the blinds/curtains open during sunny days to help heat the home but close them at night to help to insulate the home.
- Make sure that the home’s heating and air conditioning system has been checked and is performing well to maintain efficiency.
- Ensure that the windows in the home are sealed and that cold air isn’t entering the home.
Housing is already the largest expense in a household, don’t let winter energy costs ruin the monthly budget. You can find more information to share with your consumers at www.energy.gov.
Service Authorization Request Training Video Now Available
Are you a new provider offering services in the Partners catchment area? Are you newly contracted with us or do you have new staff who submit Service Authorization Requests (SARs) to Utilization Management (UM)? Please check out our new instructional video on “How to Submit a SAR”, located on the Provider Knowledge Base Utilization Management page (https://providers.partnersbhm.org/utilization-management/).
This video provides instructions on how to submit a SAR using the Alpha MCS system with tips and commonly missed items. For example, how to identify a diagnosis using the ICD-10 code, how to upload a document to the SAR, guidelines around start and end-dates, how to check for provider communication notes and how to check the status of a SAR after submission. Also, contact information for the UM Department is provided for questions. If you have any follow-up questions after watching the video, please call the Mental Health/Substance Use UM Workgroup at 704-842-6436.
Alerts and LME/MCO Joint Communication Bulletins
Provider Alerts are sent to all providers subscribed to receive Partners’ Provider Communications. Published alerts are available on the Provider Knowledge Base at https://providers.partnersbhm.org/provider-alert-archive/.
Alerts issued since the last Provider Bulletin:
December 3, 2018 – Innovations Provider Referral Process; Training; Provider Webinar
December 11, 2018 – AlphaMCS 2.08 Build
All LME-MCO Joint Communication Bulletins are located at http://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins. No Joint Communication Bulletins have been issued since the last Provider Bulletin:
Providers are encouraged to review the monthly Medicaid Bulletin. Bulletins are posted at https://dma.ncdhhs.gov/documents/2018-medicaid-bulletin-and-index.
Training, Announcements and Reminders
Health Information Exchange/NC Tracks Updates
All providers must be enrolled in NC HealthConnex by June 1, 2019 or have a State-Approved Extension by that date to continue to receive payment.
Providers are reminded to pay attention to notifications from NC Tracks for the latest information regarding a variety of topics, including recredentialing and NC Health Connex. You can sign up for emails from NC Tracks by visiting https://www.nctracks.nc.gov/content/public/providers/getting-started.html.
No Partners Provider Council in December: Partners Provider Council will not meet in December. Meetings will resume on Friday, Jan. 25, 2018 at Partners Hickory Office, Basement Multipurpose Room. Providers meet from 9:30-10:30 a.m., and Partners employees join the meeting from 10:30 a.m.-12 p.m.
The Partners Provider Council is a professional representative and advocate for all service providers in the Partners’ catchment area. The Council facilitates an open exchange of ideas and brings forward concerns and solutions while promoting collaboration and mutual accountability among providers. All providers are welcome to attend Provider Council meetings. To learn more, please visit https://providers.partnersbhm.org/provider-council/.
Connect Catawba Resource Forum: The Connect Catawba Resource Forum is coming up on Tuesday, Jan. 8, 2019 from 8-10 a.m. at the Newton Recreation Center (back entrance, lower level). We will have a special documentary screening of the film “Resilience – The Biology of Stress & the Science of Hope.” There will be a discussion afterward about how we can be part of the solution to creating more resilient communities.
Our ultimate goal is to improve the ways our community accesses the important services you offer. It is our hope that everyone will have an easier time being CONNECTed to CATAWBA County services and resources! Want to learn more? Please contact Kim Rhoads at firstname.lastname@example.org or call 828-323-8049. To register, click here.
Child & Family Team 1 “An Introduction to Child and Family Teams: A Cross System Training from the Family’s Perspective” (Registration)
Monday, January 14, 2019, 9 a.m.- 4 p.m. and Tuesday, January 15, 2019, 9 a.m.-4 p.m., Elkin Regional Office
Description: CFT 1 is a two-day experiential training with a goal of providing an overview of Child and Family Team meetings from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing Child and Family Teams through the lens of multiple systems as they affect families in their everyday lives. Agency representatives and parents/family members over 18 years of age are encouraged to attend this training.
Trainer: Stephanie Funderburk, System of Care Liaison, Partners
NC START West Clinical Education Team Meeting: Please Join the NC START WEST Team for a Clinical Education Team (CET) Meeting on Jan. 15, 2019 from 2-4 p.m. at Partners’ Hickory Office, 1985 Tate Blvd. Hickory, NC, Basement Multipurpose Room. Join us as we do a case presentation. Please feel free to invite coworkers or others that may be interested!
This is an educational forum. This training will present descriptions of the problems faced, strengths and resources, as well as diagnosis and treatment information so that the individual presented will serve as an example for discussion and further examination. It is expected that the discussion will generate ideas about possible remedies to improve services and clinical outcomes to explore for the individual presented as well as others with similar challenges.
Managing Pain in the Age of the Opioid Crisis: This event was cancelled due to the hurricane. All previous registrants for the Sept. 15 training will need to re-register.
This inter-professional event will provide timely and relevant continuing education for medical prescribers and behavioral health professionals in the midst of the opioid crisis. Topics include evidence-based analysis of the relative effectiveness of medications and their side effects, treatment recommendations for acute and chronic pain, and recognizing substance use/opioid use disorder (SUD & OUD), as well as statistics and nuanced data on prescribing and substance abuse patterns in Gaston County. The North Carolina Medical Board will provide important updates in state laws and explore legal and ethical dilemmas associated with prescribing opioids in North Carolina.
The event will be held on Saturday, Jan. 26, 2018 (Snow date: Feb. 2) at Gaston County DHHS, 330 Dr. Martin Luther King Jr. Way, Gastonia, NC 28052 from 7:30 a.m.-12:30 p.m. The event is free, however, registration is required. To register, please visit https://mahec.net/event/57808. For more details, please contact Mountain AHEC at email@example.com.
Parents Supporting Families—An Introduction to Peer Support for Families with Children Who Have Mental Health or Substance Abuse Issue:
Individuals with personal experience can learn how to use their experience in parenting a child who has a mental health or substance abuse issue to support other parents. Topics covered during this training:
- How to Share your Story
- Who is a Family Partner
- Requirements to be a Certified Family Partner
- Understanding Grief
- Core Values and Principles of System of Care
- Conflict Resolution
- Futures Mapping
This training is mandatory for National Certification and future NC Medicaid billing. The structure of the training is a three-day training with a two-day follow up. During the two-day following up training you will receive a certificate of completion.
Date and Time: Monday, Feb. 4 – Wednesday, Feb. 6, 2019 from 9 a.m.-4 p.m.
Location: Catawba Valley Behavioral Health, 20 4th Street SW, Hickory, NC 28602
Registration: Registration is required. To register, call NC Families United at 336-395-8828 or email Renee Cordero at CorderoRH@gmail.com
NAMI Lake Norman/Iredell Offers Mental Health Classes: NAMI Peer-to-Peer is a free, eight-session educational program for adults with mental illness who are looking to better understand their condition and journey toward recovery. This in-person group experience provides the opportunity for mutual support and positive impact. You can experience compassion and reinforcement from people who relate to your experiences. Through your participation, you have the opportunity to help others grow. This is a confidential place to learn from shared experiences in an environment of sincere, uncritical acceptance. Recovery is a journey, and there is hope for all people living with mental illness.
NAMI Peer-to-Peer helps you:
- Create a personalized relapse prevention plan
- Learn how to interact with health care providers
- Develop confidence for making decisions and reducing stress
- Stay up-to-date on mental health research
- Understand the impact of symptoms on your life
- Access practical resources on how to maintain your journey toward recovery https://www.nami.org/Find-Support/NAMI-Programs/NAMI-Peer-to-Peer
This free, eight-week course is being taught by a team of trained NAMI volunteers. Classes will be held weekly beginning on Saturday, Feb. 9, 2019 from 11:30 a.m. to 1:30 p.m. at Fifth Street Ministries, 1421 5th St, Statesville, NC 28677. To register or receive more information, please contact Mike Hoffman at 843-245-6189 or via email at firstname.lastname@example.org. Space is limited to the first 25 registered participants.