Provider Bulletin #94

Enrollment Requests Submitted by Contracted Providers

To facilitate timely access to services, ALL contract providers are expected to complete the AlphaMCS member enrollment correctly, in its’ ENTIRETY (two pages total) on uninsured members in the following instances and submit to Partners within seven calendar days. *Please note weekends and holidays are included in this seven-calendar day period.

  • When the individual/member walks into the provider’s office/agency requesting services and the contract provider initiates services, the enrollment should be completed, dated and submitted on the first date of service.
  • All Enrollment Requests must be submitted to Partners within seven calendar days of assessing and enrolling the consumer. No Exceptions.

Appointment Scheduling

Providers offering appointments through the AlphaMCS Slot Scheduler need to ensure that appointments are scheduled correctly. Please make sure that your appointments account for the:

  • Correct operating hours over any holiday periods
  • 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. This will assist us to best serve our members. If you have any questions, please contact Access to Care at 1-888-235-4673.

Rutherford Transition Updates

On July 1, 2019, persons with Rutherford County Medicaid and persons receiving State Funded services through providers in Rutherford County, being served through Vaya Health (Vaya) will be served through Partners Behavioral Health Management (Partners). Providers that are new to Partners are encouraged to check out our Provider Knowledge Base website at https://providers.partnersbhm.org/ as well as the Provider Orientation Toolkit and Operations Manual.

Providers should be aware of the following in regard to the transition:

Member Communication

Beginning this week, Rutherford members who have received behavioral health or intellectual and developmental disability services managed by Vaya during the last 12 months will receive a letter regarding the transition.  Anyone who has questions related to the transition can:

NC-TOPPS

The purpose of this communication is to help NC-TOPPS providers understand their role with the Rutherford County transition. This information will only apply to Rutherford County members and members with Medicaid out of Rutherford County.

Providers will not have to transfer existing interviews of members in NC-TOPPS. The process of moving these members from Vaya to Partners will be completed by NC-TOPPS. After the transition, any NC-TOPPS interview affected by this, will be found under Partners and will use record numbers generated by Partners. The record number will be the only identifying information that will be updated in this system other than the NC-TOPPS record being transferred under the Partners location.

Initial NC-TOPPS interviews submitted after July 1, 2019 will need to be submitted under the Partners location and use the Partners’ record number. This number will need to be obtained by providers prior to submission.

Each member will require a new NC-TOPPS Release of Information (ROI) signed by the member, parent or guardian with the effective date of July 1, 2019.  A copy of this ROI can be found on the NC DHHS website or at the following link: https://www2.ncdhhs.gov/info/olm/forms/dsb/dhhs-1000-ia.pdf

Please contact us at one of the following email addresses with any questions as we are committed to ensuring that you have all the necessary information for a successful and timely transition of NC-TOPPS interviews.

Utilization Management

  • Enhanced Service Providers: On July 1, NC Tracks will assign the Medicaid Eligibility for Rutherford members to Partners.  In addition, providers will need to begin enrolling all state-funded and enhanced Medicaid members as they show up for an appointment after June 30, 2019. The exception will be for members receiving a state-funded daily service. For these services, please follow the instructions listed under Rutherford County Providers Enrollment Process for State-Funded Daily Service Members.  Partners will begin enrolling members whose services are funded through State Funding. Partners Utilization Management will enter all authorizations needed for members in order to eliminate any undue administrative burden onto providers.   However, we will need your assistance.  With the exception of Basic Services, Partners needs to have information for any unmanaged authorizations which need to continue after July 1, 2019.  Please complete the Unmanaged Authorizations Spreadsheet (click here for fillable spreadsheet) and return (via encrypted email) to Jennifer Shain at jshain@partnersbhm.org.  Partners encourages providers to continue to deliver service at the same rate as members received on June 30, 2019.
  • Rutherford County Providers Enrollment Process for State Funded Daily Service Members: For all members receiving State Funded daily services please fully complete the State Funded Daily Services Enrollment Form (click here for fillable form). After completion, please fax to Partners BHM, Attn: Rutherford Co. Enrollment at 336-835-2075 no later than 3:00 p.m., Wednesday, June 26, 2019, or email (via encrypted email) to EligibilityEnrollment@partnersbhm.org within the same timeline.
  • ICF-IID Providers: If you have members whose authorization(s) do not match their approved Level of Care (LOC), please contact Partners’ IDD UM Department with the Provider Name, Member Name, Date of Birth,  and Dates of LOC document.  This information can be sent via encrypted email to Roxann Revels at RRevels@partnersbhm.org.  Please hold additional documentation at this time.
  • Service Authorization Requests: Partners is in the process of preparing for the Rutherford County member transition to become effective July 1, 2019.  As part of that preparation, we will be working toward adding the Rutherford County members to our AlphaMCS database.  During this transition period, we will not be able to process any Service Authorization Requests (SARs) for Rutherford County members until July 1, 2019.  Therefore, please do not begin submitting SARs for those members until that time.  If we do receive SARs for Rutherford County members prior to July 1, they will be returned as “Unable to Process” since Partners will be unable to verify current eligibility until July 1.

Partners will release a Provider Alert regarding any documentation needs Utilization Management may have after the transition.  In the communication, it will tell you what to provide and how to provide the information.  We are doing our best to prevent duplication and undue burden for providers. Thank you for your cooperation and assistance.

Claims Information

Providers should send all inquiries to claimsdepartment@partnersbhm.org so they are handled in the most efficient manner. Please do not send email directly to individual employees. 

AlphaMCS Portal University is an available resource and guide for navigating AlphaMCS.  If you need additional claims training, email rcolvard@partnersbhm.org to schedule a time for training.

Explanation of Benefits requests for Coordination of Benefits Claims:  As a reminder, Partners does request copies of the Explanation of Benefits for consumers/claims submitted indicating Coordination of Benefits. The request will originate via email from Partners Claims staff. 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.

Denied Claims:  As of June 5, 2019, providers may have started receiving denials for the reason below. Providers should rebill the claim with a valid corresponding diagnosis code.

Any inactive, end dated, or incomplete diagnosis code submitted on any claim will cause the entire claim to deny for reason 115.

Medicaid—May 2019:   Number of Days to Process and Pay All Claims
Received Date to Paid Date: 9.2
Top Five Medicaid Claim Denials—May 2019

Claim Denial

Provider Recommended Action Steps
Duplicate Claim The claim has previously been submitted and adjudicated. Do not refile.
Service is not authorized Verify Service Authorization for the consumer. Contact Utilization Management.
Claim received after the billing period Write off charges as non-billable. Do not rebill.
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.
Client has other covered insurance. Ensure primary insurance for the member has been billed and is indicated in the claim submitted to the MCO.

Reminder – Checkwrite Cutoff Dates Extended

As noted in a Provider Alert dated June 14, 2019, Partners will extend the checkwrite cutoff for both State and Medicaid for the next two weeks:

  • For the week beginning Sunday, June 16, the checkwrite cutoff will be June 20, 2019, instead of June 18, 2019.
  • For the week beginning Sunday, June 23, the checkwrite cutoff will be June 27, 2019, instead of June 25, 2019.

If you have questions, please contact the Claims Department by calling 704-842-6486 or email claimsdepartment@partnersbhm.org.

Questions about Incidents and IRIS? Here’s who to call

A waiver is in place for the submission of the Quarterly Level I Incident Report, however, there are times that providers may need to reach Partners’ employees regarding other types of incidents. Here’s who you need to contact:

General Questions about IRIS/Incidents Email: iris@partnersbhm.org
Level III Incident Reporting Deborah Jackson, phone: 704-772-4294, email: djackson@partnersbhm.org
Level II Incident Reporting For incidents in Cleveland, Gaston, or Lincoln:
Deborah Jackson, phone: 704-772-4294,
email: djackson@partnersbhm.orgFor incidents in Burke, Catawba, Rutherford or Out-of-State PRTF providers:
Rodney Harris, phone: 704-884-2624,
email: rcharris@partnersbhm.orgFor incidents in Iredell, Surry, or Yadkin:
Keshia Sandidge, phone: 704-884-2698, email:  ksandidge@partnersbhm.org

Introducing #CareForNC

Partners is pleased to be part of the Partnership for Community Well-Being and the #CareForNC campaign to highlight the personal and community stories of those served by North Carolina’s public behavioral health system.

For the first time, all the LME/MCO’s and several providers have come together as the Partnership for Community Well-Being to create a common campaign.  The Partnership includes:

Alliance Health – Benchmarks NC – Cardinal Innovations Healthcare – Eastpointe – NC Providers Council – Partners Behavioral Health Management – Sandhills Center – Trillium Health Resources – Vaya Health

Since 2011, the public managed care system has helped countless North Carolinians to reach their full potential and strengthen their communities. We have seen first-hand the tremendous impact this care has had on the lives of North Carolinians.

Unfortunately, this good news and these inspirational stories can get lost in a narrative about politics and state funding. At times, this negative narrative has permeated public perception and caused people to lose sight of the successful public system that has built a foundation of well-being throughout our state.

Through the #CareForNC campaign, we can help shift the public narrative to focus on the positive stories of people served and communities strengthened by the system. Our collective voice will help amplify these uplifting messages, and influence people to respect the many successes of the system that directly benefits you. In the coming days, we will be launching a new campaign website, generating posts for social media, and producing videos to help share these powerful stories.

Time is of the essence as we are already in the middle of the legislative season when important decisions could be made regarding the future of the system. Together, we can continue to improve health outcomes and strengthen our communities.

Be on the lookout for news about the campaign materials and more information about how you can help us ensure we all #CareForNC!

Partners Training Academy

All Partners Training Academy sessions are free to registered attendees. Register in advance at www.PartnersTraining.com. If you have any questions about Partners Training Academy events, please email Training@PartnersBHM.org.

Provider Orientation

9:00 a.m. – 12:00 p.m., Gastonia: August 1, September 5, or October 3 (click a date to register)

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.

LOCUS 

Friday, September 13, 2019, 9:00 a.m. – 12:00 p.m., Hickory (Registration)

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

CALOCUS

Friday, September 13, 2019, 1:00 p.m. – 4:00 p.m., Hickory (Registration)

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.com.

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 email training@partnersbhm.org.

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

  • Gastonia Auditorium: July 16, 12:00 – 1:00 p.m. (Registration)
  • Hickory Multipurpose Room (B03): July 18, 12:00 – 1:00 p.m. (Registration)
  • Elkin Conference Room A/B: July 18, 12:00 – 1:00 p.m. (Registration)

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, please visit https://www.partnersbhm.org/subscribe/.

Alerts issued since the last Provider Bulletin:

June 5, 2019 – AlphaMCS 2.12 Build

June 14, 2019 – Extended Checkwrite Cutoff Dates

All LME-MCO Joint Communication Bulletins are located at http://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins.

This month’s bulletins:

  1. Joint Communication Bulletin #J329 Home and Community Based Services Heightened Scrutiny Guidance
  2. Joint Communication Bulletin #J328 Amendment to J301 Revised In-At-Risk Checklist
  3. Joint Communication Bulletin #J327 TCLI In-Reach and Diversion

Providers are encouraged to review the monthly Medicaid Bulletin. Bulletins are posted at https://medicaid.ncdhhs.gov/providers/medicaid-bulletins.

Training, Announcements and Reminders

LIP Collaborative:  The Licensed Independent Practitioner Collaborative will be held on Thursday, June 27 at 12 p.m. via webinar. To register, please visit https://providers.partnersbhm.org/licensed-independent-practitioners-collab/.

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 will meet July 11, 2019, 10 a.m.-12 p.m. at Little Joe’s Chapel, Children’s Hope Alliance, Barium Springs, NC.

Our speaker is Dr. Anne Doucette, Ph. D, LPCS.  Anne is the clinical director at RHA-NC START West and will provide training on treatment of Fetal Alcohol Syndrome. Anne is an effective, collaborative and systems-oriented clinician, manager and educator with 40 years of clinical and management experience in human services.  Competencies include program management, supervision, teaching, clinical assessment, therapy, treatment planning, crisis response, psychiatric case management, and coaching families.

Her clinical experience includes the following:

  • Specialize in clinical assessment, treatment and crisis response for individuals with intellectual/developmental disabilities and co-occurring mental health and behavioral challenges.
  • Produced successful treatment outcomes as a Psychologist in a state-operated system and as a Clinical Consultant for specialized outreach programs supporting individuals, their families, and care providers.
  • Skilled in developing positive support plans using strength-based and person-centered approaches.
  • Achieve positive results as a supervisor of clinical and direct support professionals using a collaborative coaching style.

To learn more or register please contact Jeanne Patterson at 828-446-4936 or email jpatterson@partnersbhm.org.

Iredell County Community Health Assessment Survey:
The Iredell County Health Department is initiating a comprehensive community health assessment of our community. The purpose of the assessment is to understand the current health needs of residents in Iredell County and to help identify where and how we can improve the health of our community. The assessment includes a review of various sources of data along with a survey of county residents.

The Community Health Assessment survey asks about personal health and wellness as well as priorities to improve health. Individual responses from Iredell County Citizens will add vital information and insight to our assessment. The survey is available in both English and Spanish on the Iredell County Health Department website, or at the links below.

English: https://www.surveymonkey.com/r/IredellCHA
Spanish: https://www.surveymonkey.com/r/CHA2019SP

Hard copies of the survey can be found at the Iredell County Health Department Statesville and Mooresville locations, as well as the Statesville Public Library, Troutman Public Library, and Harmony Public Library.

Every four years a Community Health Assessment is developed by the Iredell County Health Department to evaluate the health needs of our community and assess the services available to our residents. Information from a variety of demographic, epidemiological and community sources are gathered to develop a comprehensive picture of areas of strength and areas in need of improvement. Collecting data and analyzing trends gives us a better understanding or where we are and how we, as a community, should focus our attention and resources in the future.

The deadline to complete the survey is July 1, 2019. We anticipate that the 2019 Community Health Assessment will be available in spring 2020.

For more information or to get involved with the Healthy Carolinians Taskforce and Community Health Assessment efforts, please contact Megan Redford at megan.redford@co.iredell.nc.us  or 704-924-4089.

NAMI Lake Norman/Iredell Offers Mental Health Classes:  The Wellness Recovery Action Plan® or WRAP® is a self-designed prevention and wellness process that anyone can use to get well, stay well and make their life the way they want it to be. It was developed in 1997 by a group of people who were searching for ways to overcome their own mental health issues and move on to fulfilling their life dreams and goals.  It is now used extensively by people in all kinds of circumstances, and by health care and mental health systems all over the world to address all kinds of physical, mental health and life issues.

WRAP Wellness Toolbox helps you:

  • Develop a list of resources used to develop your WRAP. Learn how to interact with health care providers
  • Contacting friends and supporters, and peer counseling
  • Relaxation and stress reduction techniques, journaling, affirming activities.
  • Exercise, diet, light, and getting a good night’s sleep.

To learn more about WRAP, check out this website: https://mentalhealthrecovery.com/wrap-is/

This free, eight-week course is being taught by a team of trained WRAP volunteers.  Classes will be held weekly beginning on Saturday, July 13, 2019, from 11:30 AM to 1:30 PM at the 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 hoffmanm679@gmail.com Space is limited to the first 25 registered participants. Learn more about NAMI Lake Norman/Iredell at www.namilakenormaniredell.org.

NAMI of South Mountains Resource Fair:  Join NAMI South Mountains, NC for at a Resource Fair to learn about NAMI (National Alliance on Mental Illness). This event will be held Wednesday, July 17, 2019, from 9 a.m.-3 p.m. at Partners’ Auditorium, 901 S New Hope Rd, Gastonia, NC 28054. NAMI advocates, supports, and offers free education, and looks forward to meeting you. If you have any questions, please contact Diane Krisanda at 828-771-6305.

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, July 29 through Friday, August 2 at 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 hrs0418@yahoo.com.  This training is possible through a grant from Recovery Communities of NC (funded by NC DHHS and SAMHSA).

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