Partners’ Provider Council: 2019 Charter Feedback Requested
Partners Provider Council is working on our 2019 Charter. The 2019 Charter Subcommittee is working on determining which agencies will be voting members on the council. If you would like to remain or become a voting member, please complete the short Form of Interest linked below. Only one survey needs to be completed per agency. Once we have a list of interested agencies, we will create a ballot and the council will vote on council membership in June 2019. All agencies are welcome to attend the council meetings regardless of membership. Please submit your 2019 Partners Provider Council Voting Membership Form of Interest by visiting https://www.surveymonkey.com/r/LRJMTPX by May 31. Submissions will not be accepted after May 31.
Partners’ Provider Council will meet on Friday, May 24, 2019, at Partners’ Hickory Office, Basement Multipurpose Room. Providers meet from 9:30 a.m.-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 representation of the network and advocates 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/.
Partners’ June Provider Webinar
Partners will host its next quarterly Provider Webinar on Wednesday, June 12 from 1 p.m.-3 p.m. Click here to register. To view past webinars, slide decks, and handouts, please visit https://providers.partnersbhm.org/provider-webinars-forums/. Please contact Roanna Newton at 828-323-8054 or email firstname.lastname@example.org with any questions.
2019 Perception of Care Survey Reminder
Quality Management (QM) Monitoring Specialists have now contacted all providers who were selected to participate in this year’s Perception of Care Survey, and survey packets should have been delivered.
Please remember that the survey period began Monday, May 6, 2019 and will end Tuesday, June 4, 2019. All surveys need to be returned to Partners before Friday, June 7, 2019.
Providers can return the surveys to Partners in the following ways:
- contact your QM Monitoring Specialist for pick-up; or
- send/deliver to April Corder at Partners’ Corporate office, 901 S. New Hope Road, Gastonia, NC
Please direct requests for additional surveys, surveys in Spanish, or any other questions regarding this year’s survey implementation to April Corder at 704-884-2591, email@example.com or to Bill Rankin at 704-884-2688, firstname.lastname@example.org.
Partners expresses its gratitude for your assistance in administering the 2019 Perception of Care survey.
IRIS Upgrade Postponed to May 31
The upgrade for the IRIS servers has been postponed to Friday, May 31st. As a result, the IRIS websites will be unavailable from 6:00 a.m. on Friday, May 31st until 7:00 a.m. on Monday, June 3rd. If the system becomes available earlier, this information will be posted on the IRIS website and the LME-MCO staff will be notified. If you/your agency have any questions, please email email@example.com
Since IRIS reports are due within 72 clock hours from the time that the provider learns of an incident, providers may obtain a hard copy of the report from the IRIS website (https://iris.dhhs.state.nc.us/) before Friday, May 31 or print forms from the DHHS website at https://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms. Reports can be submitted to the LME-MCO (Host and Home) via their fax (Partners IRIS Staff Fax: 704-884-2620) and to DMH/DD/SAS Customer Service and Community Rights Team via fax at 919-733-4962 within specified timeframes and procedures. Providers will still need to enter the report into IRIS once the system is available. Reports to be filed with DHSR Healthcare Personnel Registry should be faxed to HCPR within specified timeframes at 919-733-3207. Reports regarding Deaths (suicide, homicide/violence, accident or restraint) in a licensed facility should be reported to DHSR Complaint Intake Unit via fax at 919-715-7724.
In Lieu of Service—Outpatient Plus
Effective July 1, 2019, qualified providers in the Partners’ network can add Outpatient Plus (In Lieu of Service) to their service array.
Outpatient Plus (OPT Plus) is a combination of best practice outpatient therapy services, monitoring, support, and management of care interventions to be provided for individuals with complex clinical needs that traditional outpatient cannot adequately address. OPT Plus is a level of care between Outpatient and Intensive In Home/Community Support Team. View the Outpatient Plus Service Definition at https://providers.partnersbhm.org/service-definitions/ for full details.
Providers interested in adding Outpatient Plus should submit a Provider Change Form, located at https://providers.partnersbhm.org/provider-enrollment-credentialing/, to add the new service code for the site. If you have questions, please contact your Account Specialist for further information.
Partners’ Provider Integrated Care Initiative
Partners’ Integrated Care Team is developing the Provider Integrated Care Initiative (PICI) to help behavioral health agencies enhance services and improve outcomes for members through whole person care. Partners’ Integrated Care Team is working with provider agencies to learn how agencies address members’ social and physical health through the adoption of the Social Determinants of Health (SDOH) tool and primary care collaboration strategies.
The data gathered will be used to by Partners’ staff to develop technical assistance and a series of webinars. The goal of the initiative is to help providers enhance services, develop resources for members, collaborate with physical health providers, and highlight the importance of including whole person care during treatment planning.
The Provider Protocol Initiative is in the development stages. If you would like to take part, or have questions, please contact Jennifer Greene at JGreene@partnersbhm.org.
Join Partners and NC MedAssist in #DispensingHope
Partners has built a collaborative relationship with NC MedAssist to bring mobile pharmacy events to members in our catchment area to help address one of the social determinants of health–access to medications. This fiscal year, Partners has provided volunteers for events in Kings Mountain and Lincolnton and contributed both volunteers and financial support to the Morganton and Statesville events. Thanks to these efforts, along with the help of several community partners, Partners and NC MedAssist served 1129 individuals during the Morganton and Statesville events. Community partnerships include Burke Recovery, Burke County Health Department and Iredell County Health Department, Burke Integrated Health, ALFA, Burke Health Network, Iredell Health Systems, Iredell EMS, Statesville Family Medicine, Piedmont Healthcare, DACI, Insight, Council on Aging, and Statesville Police Department and the YMCA.
NC MedAssist is an excellent resource for your clients to receive over the counter medications and link to MedAssist’s program for access to medical and psychiatric prescription medications at a reduced cost. The events are open to anyone in the community regardless of income level and insurance.
- Surry County: Friday, May 17 from 9 a.m. -2 p.m., Jones Family Resource Center, 215 Jones School Rd., Mt Airy, NC 27030 View Flyer
- Gaston County: Friday, May 31 from 9 a.m. -2 p.m., Common Ground Campus of Stanley, First United Methodist Church, 5481 Hickory Grove Rd., Stanley, NC 28164 View Flyer
- Yadkin County: Saturday June 15 from 9 a.m. – 2 p.m., Yadkin Valley Senior Center, 121 Delose Martin Dr., Jonesville, NC View Flyer
Providers should send all inquiries to firstname.lastname@example.org so they are handled in the most efficient manner. Please do not send email directly to individual employees.
Claims Accuracy and Timeliness Audit Results: Partners Behavioral Health Management recently received the results of the Claims Accuracy and Timeliness Audit performed and prepared by HMS on behalf of North Carolina Department of Health and Human Services, Division of Health Benefits. The intent of the audit was to validate processed claims and identify overpayments, underpayments and processing errors made in the plan. In addition, HMS reviewed the claims to ensure the timeliness of provider payments.
|Claims Accuracy and Timeliness Audit: Summary Findings|
|Timeliness of Provider Payments (within 30 days)||100%||Compliant|
|Claims Processing Accuracy||99.99%||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.
Medicaid—April 2019: Number of Days to Process and Pay All Claims
|Received Date to Paid Date:||8.8|
Top Five Medicaid Claim Denials—April 2019
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.|
|Claim received after the billing period||Write off charges as non-billable. Do not rebill.|
|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.|
Exception to Benefit Plan Limits for Inpatient Services
The following was shared in a Provider Alert on May 6, 2019
Partners Utilization Management (UM) allows a maximum of three days to be requested for all Medicaid (0101) and State-funded (YP820) Inpatient Service Authorization Requests (SARs). If you have questions, please contact Partners’ UM Inpatient Review at 704-842-6434.
Effective June 20, 2018, Partners began allowing an exception for SARs with a length of stay covering weekend days. Specifically, hospitals submitting SARs with a start date of Thursday can request an additional day to extend the maximum allowed days requested to four (allowing a request for Thursday, Friday, Saturday and Sunday). A continued stay SAR would have to be submitted on or by Monday.
Effective April 24, 2019, Partners has begun a similar exception for holidays that fall on a Monday. Hospitals can submit a SAR for up to four days if the SAR is submitted with a start day of Friday (requesting Friday, Saturday, Sunday and the Monday holiday). A continued stay SAR would have to be submitted on or by Tuesday.
Utilization Management Inpatient staff will remain available seven days a week, including holidays, 8:00 a.m. until 7:00 p.m. Hospitals can continue to submit SARs with any start day. All Inpatient SARs will be reviewed for Medical Necessity.
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.
Description: Join Partners’ Provider Network, Claims, Access to Care, Utilization Management, Care Coordination, and Quality Management staff for an interactive provider orientation. These open-house style events will allow attendees time to work one-on-one with Partners’ staff to discuss any issues or unfamiliar topics. Participants are encouraged to bring their own laptops to access and review their specific workflow.
These sessions will reoccur monthly on the first Thursday of each month from May – October 2019 (excluding the month of July due to the Independence Day holiday).
These training sessions are open-house style with no formal presentation or start time. 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 these orientations is not limited to only providers who are new to Partners’ network, but it is advised that attendees already have access to AlphaMCS prior to attending a session.
Person Centered Planning/Documentation (Class Full)
Thursday, May 30, 2019 – Friday, May 31, 2019, 9:00 a.m. – 4:30 p.m., Hickory
Description: Documentation/Person Centered Planning Training – This training is an instructional course on the essential elements of documentation. Participants will develop awareness and skills to enhance documentation competence as behavioral healthcare providers. Participants will learn the components to writing accurate service notes using the PIE format. Additionally, participants will learn the values and core concepts of being person centered thinkers. This training will teach the instructional elements of completing the person centered plan.
- How to mitigate separating personal values, experiences, feelings, attitudes, and beliefs that may unconsciously influence the efficacy of clinical work
- How to manage challenges that arise when documenting service notes while honoring the culture, values, beliefs and preferences of clients
- How to incorporate person centered thinking methods, techniques, and tools into the development of the Person Centered Plan
- How to effectively write a comprehensive clinical service note
Target Audience: Social Workers, Counselors, Psychologists, Qualified Professionals, Peer Support Specialists, Associate Professionals, Licensed Mental Health Providers, Community Based Mental Health Agency Directors
Trainer: Danielle Coleman, MSW, LCSW, ACSW
Collaborative Care (Registration)
Wednesday, June 12, 2019, 10:00 a.m. – 12:00 p.m., Gastonia with video conference to Hickory and Elkin
Description: Throughout the course of the year, Partners Training Academy has introduced to providers components of the Collaborative Care Model. This training connects those components together to go deeper in application of Collaborative Care. Per the AIMS (Advancing Integrated Mental Health Solutions) Center, Collaborative Care is a specific type of integrated care developed at the University of Washington, and adapted by Partners, that treats common mental health conditions that require systematic follow-up due to their persistent nature, such as depression and anxiety. Based on principles of effective chronic illness management, Collaborative Care focuses on defined patient populations tracked in a registry, measurement-based practice, and treatment to target.
Participants in this training will:
- Review the core principles that make up the Collaborative Care Model
- Enhance understanding of the Team Structure and Partners’ adaptations to the Collaborative Care Model Team Structure
- Explore financing strategies
- Address efforts to meet success in the community from clinical, financial and political perspectives
Trainer: Jennifer Greene, MA, LPC, Integrated Care Project Manager, Partners
Friday, September 13, 2019, 9:00 a.m. – 12:00 p.m., Hickory
Description: Level of Care Utilization System for Psychiatric and Addiction Services – Service providers are required to use the Level of Care Utilization System for Psychiatric and Addiction Services, or LOCUS, clinical tool to evaluate and determine the level of psychiatric or addiction services care needed for adults. This training is conducted by Partners’ Mental Health and Substance Use Utilization Management staff. This hands-on training includes the review of a case and use of the LOCUS screening form to score the level of care needed.
Target Audience: Persons responsible for service authorization requests for mental health and substance use services.
Trainer: Partners BHM MH/SU Utilization Management Department
Friday, September 13, 2019, 1:00 p.m. – 4:00 p.m., Hickory
Description: Child and Adolescent Level of Care Utilization System for Psychiatric and Addiction Services – Service providers are required to use the Child and Adolescent Level of Care Utilization System for Psychiatric and Addiction Services, or CALOCUS, clinical tool to evaluate and determine the level of psychiatric or addiction services care needed for individuals ages 6-18. This training is conducted by Partners’ Mental Health and Substance Use Utilization Management staff. This hands-on training includes the review of a case and use of the CALOCUS screening form to score the level of care needed.
Target Audience: Persons responsible for service authorization requests for mental health and substance
Trainer: Partners BHM MH/SU Utilization Management Department
Register online and find additional training opportunities at www.PartnersTraining.org
Disability and Reentry Employment Summit
Date and Time: May 30, 2019, 7:30 a.m.- 9:30 a.m. (Registration)
Location: Gastonia Conference Center – 145 Dr Martin Luther King Jr Way, Gastonia, NC 28052
Individuals with mental illness and reentry are a diverse group of people with a wide range of talents and abilities. The majority of individuals with serious mental illnesses express a desire to work, yet employment rates for this demographic are estimated to be only twenty-two percent.
Employment provides more than a paycheck: a sense of purpose, opportunities to learn, and a chance to work with others. Most importantly, employment offers hope, which is vital to recovery from mental illness, and provides a fresh start for those at-risk.
As a part of the Disability & Reentry Employment Summit, we invite you to explore ways your business could be missing out on qualified applicants and learn how to participate in equitable hiring. Topics featured:
- Equitable Hiring
- Incentive Protections
- Work Release Program
- Legal Protections and Guidelines
Breakfast will be provided to all registered attendees. This event is hosted by Partners Behavioral Health Management, in partnership with NC Commerce, Gaston Chambers, Gaston Workforce Board, Vocational Rehabilitation, Goodwill, Gaston County School District, Monarch, Inc., and Coastal Southeastern United Care. For more information, contact Ryan Shuford by email at RShuford@partnersbhm.org or call 704-884-2579.
Opioid Lunch & Learn Series
Best Practices in Opioid Prescribing and Management: A CME Lecture Series, presented by Northwest Area Health Education, a program of Wake Forest School of Medicine and a part of the NC AHEC System.
Join Northwest AHEC at Partners’ offices for monthly opioid-focused lectures delivered in a lunch-and-learn format. Registered participants will receive lunch, and Continuing Education Unit(s) for each session attended on behalf of Northwest AHEC.
Continuing Education Credits:
Each course provides the following credit options after completing and passing a post-test and completing the online evaluation:
- The Wake Forest School of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- Continuing Nursing Education (CNE) Contact Hours
The Wake Forest School of Medicine is accredited by the Accreditation Council of Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Registration: Advanced registration is required. Register online via the training calendar at www.PartnersTraining.org or the registration links. Additionally, you are required to create a MyAHEC account if you do not already have one. Instructions to do so will be emailed to registered participants prior to their first lecture.
If you have any questions regarding the Opioid Lunch & Learn Series, please contact Kali Sbalbi, Training & eLearning Coordinator, at KSbalbi@PartnersBHM.org or 704-884-2669.
Program Topics and Objectives:
“Strategies for Safe Opioid Discontinuation in Chronic Use Patients”
Define Opioid Use Disorders (OUD), review medications involved in OUD, identify strategies for opioid discontinuation, and describe medication assisted therapy (MAT) options
Enhanced Child Services Collaborative
The Enhanced Child Services Collaborative is an opportunity for providers of enhanced child services to come together to share resources and receive training about resources and services available for our consumers. The group meets every other month at Little Joe’s Chapel, Children’s Hope Alliance, Barium Springs. The collaborative normally meets on the first Thursday of the month, however, the group will meet on July 11, 2019 due to the holiday, from 10 a.m.-12 p.m., at Little Joe’s Chapel, Children’s Hope Alliance, Barium Springs, NC. To learn more or register please contact Jeanne Patterson at 828-446-4936.
Alerts and LME/MCO Joint Communication Bulletins
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 (Provider Alerts, the Provider Bulletin, or Behavioral Health Focus), please visit https://www.partnersbhm.org/subscribe/.
Alerts issued since the last Provider Bulletin:
- April 22, 2019 – HFW Request for Proposals; Provider Council Meeting
- April 24, 2019 – AlphaMCS 2.11 Build
- April 29, 2019 – Utilization Management Update: Unmanaged Units for Outpatient Behavioral Health Services
- May 6, 2019 – Exception to Benefit Plan Limits for Inpatient Services, NCI Staff Stability Survey
All LME-MCO Joint Communication Bulletins are located at http://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins.
This month’s bulletins:
- #J323 Extension of NC’s 1915 (b) Waiver and Concurrent 1915 (c) Innovations Waiver
- #324 Requests for Continuation of Benefits
Providers are encouraged to review the monthly Medicaid Bulletin. Bulletins are posted at https://medicaid.ncdhhs.gov/providers/medicaid-bulletins.
Provider Annual Seminar – Fayetteville, NC: As a reminder, there is another seminar coming up soon. Please see the details below. For more information on this seminar and others, including how to register, please see this announcement.
Provider Annual Seminar: Fayetteville, North Carolina, May 23, 2019, 9:00 a.m. – 3:30 p.m.
This seminar series will provide information including:
- Common reasons Enrollment and Manage Change Request (MCR) applications are delayed and how to avoid delays
- How to add Community Alternative Program taxonomy via MCR
- The top 10 denial reasons for Professional and Institutional claims and their resolutions
- How to indicate “other” payer detail on a claim in NCTracks
Home- and Community-Based Services Waiver Orientation and Educational Training: During the month of June 2019, NC Medicaid Long-Term Services and Supports will host a Community Alternatives Program for Disabled Adults (CAP/DA) Home- and Community-Based Services (HCBS) waiver orientation and educational training for CAP/DA HCBS providers.
This training is intended to provide an in-depth overview of the newly implemented workflow and business steps to render CAP/DA services as outlined in the renewed CAP/DA HCBS waiver application and the amended CAP/DA Clinical Coverage Policy, 3K-2. Read more
New Special Medicaid Bulletin: Posting “Notice of Your Rights Under Hawkins v. Cohen” The NC Division of Health Benefits has published a Special Medicaid Bulletin, Posting “Notice of Your Rights Under Hawkins v. Cohen,” dated May 2019. Providers are encouraged to review this important information. For details, please refer to the 2019 Medicaid Bulletin web page.
Training, Announcements and Reminders
SAMHSA Housing First and Permanent Supportive Housing Spotlight Series: SAMHSA invites you to join us for the first webinar of a three-part series on Housing First and Permanent Supportive Housing. This Spotlight Series will help providers of mental health and substance use services improve their practices and address housing instability among individuals and families affected by serious mental illness and substance use disorders (SMI/SUDs).
The first webinar, to be held on May 16, 2019 from 12 p.m.-1:30 p.m. will:
- Introduce two evidence-based practices: Housing First and Permanent Supportive Housing;
- Offer essential elements, current research and information on accessing Housing First and Permanent Supportive Housing for individuals with mental illness or substance use disorders to clinicians, peers, and other stakeholders; and
- Support SAMHSA’s strategic plan by identifying and promoting adoption of evidence-based practices.
HHRN Technical Assistance Lead Deborah (Deb) Werner, M.A., PMP, will moderate the session. Speakers include Suzanne Wenzel, Ph.D., Research Partner, Homelessness Policy Research Institute and Patricia (Pat) Tucker, M.B.A., M.A., Senior Program Manager, HHRN
Save the dates for additional webinars in the series:
- Webinar 2: Supporting People with SMI/SUD in Housing First and Permanent Supportive Housing, May 23, 2019, 3:30 to 5:00 p.m. (ET)
- Webinar 3: Funding and Policy Considerations, June 13, 2019, 3:30 to 5:00 p.m. (ET)
i2i Hosts Medicaid Transformation Webinars: Is Medicaid changing? You may have been hearing about Medicaid Transformation and how there will be changes to the way services are provided to Medicaid consumers and family members. The webinar will provide some basic information about Medicaid Transformation and how it will affect behavioral health services provided in North Carolina. This webinar is geared toward consumer and family members but is open to anyone interested in the topic.
Information to be covered in the webinar will include:
- Why DHHS is transitioning the system to managed care
- Who will be eligible to participate in the Standard Plan & Tailored Plan
- What services will be available under the Standard Plan & Tailored Plan
- When the Standard Plan & Tailored Plan will go into effect
- Where to get more information on Medicaid Transformation
Presenter: Kelly Friedlander, MSW, MPA, Project Director, Cross-System Navigation in a Managed Care Environment Initiative, i2i Center for Integrative Health
This webinar is part of the Cross-System Navigation in a Managed Care Environment Initiative, funded by the North Carolina Council on Developmental Disabilities. To find out more about Cross System Navigation Initiative, visit our website http://www.crosssystemnavigation.org/.
Division of Health Benefits Offers Medicaid Managed Care Training Courses: Providers wanting to learn more about NC Medicaid’s transition to Managed Care are urged to view and participate in available training courses. To view past courses and learn more, visit https://medicaid.ncdhhs.gov/nc-medicaid-managed-care-training-courses
i2i Spring Policy Forum: i2i Center for Integrative Health will host its Spring Policy Forum, “Pathways 2 Progress, on June 10 and 11, 2019 at the North Raleigh Hilton, Raleigh NC. To learn more and register, visit https://i2icenter.org/events/spring/.