Division of Health Benefits/LME-MCO Transition of Care Updates

Phase 1 open enrollment for Medicaid Managed Care began Monday, July 15, 2019. Two counties in the Partners’ catchment, Surry and Yadkin, are scheduled to transition to Medicaid Managed Care on November 1, 2019. To make sure you are well informed about open enrollment activities and the support available to you, please sign up to receive notifications about webinars or review previously recorded webinars available at https://www.ncdhhs.gov/assistance/medicaid-transformation.

Recently, a webinar was held for the aging and disability population about the enrollment process. This webinar shares information that may be helpful when sharing information with members. To view the presentation, click here.

The call center and website for Medicaid Managed Care are now live, meaning that Medicaid beneficiaries can now call and go online to select and enroll in a health plan. As a reminder, while all beneficiaries can access these tools, only those in Regions 2 and 4 can enroll during Phase 1. (See the NC Medicaid County Playbook for more details.)

Proposed Peer Support Service Definition

NC DHHS’ Proposed Peer Support Policy is now posted for public comment. The initial comment period for the proposed policy is 45 days from July 15, 2019, to August 30, 2019.   

To view the proposed policy, please visit https://medicaid.ncdhhs.gov/get-involved/proposed-medicaid-and-nc-health-choice-policies. Comments should be sent to medicaid.public.comment@dhhs.nc.us.gov.

Rutherford County Transition

The July 1, 2019 addition of Rutherford County was successful, thanks in large part to our provider network, local community advocates and stakeholders, and Partners staff.

The coordinated planning and cooperation of all involved paid off as the process was relatively smooth with little disruption to members. Beyond the initial transition, we have started the post-transition phase to ensure proper follow-through and that follow-up occurs where needed.

As always, if and when issues arise in the future, providers can continue to reach out to your Provider Account Specialist.

Our dedicated Rutherford County line, 704-884-2505, and email, Rutherford_Questions@partnersbhm.org, for Rutherford County members, providers and stakeholders will be active until July 31, 2019. At that time, calls will be directed to Partners Access to Care Call Center and emails should be directed to questions@partnersbhm.org.

Thank you for what you do to serve residents of Rutherford County and your commitment to our members and communities.

Annual Submission of Quality Improvement Projects

It is a requirement of Partners that providers/contractors that deliver Medicaid and/or State Funded services conduct organizational Quality Improvement Projects (QIPs). Licensed Independent Practitioners are not required to submit QIPs at this time.

Here is what Providers need to know to submit their QIPs to Partners:

  1. 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.)
  2. The contact person in your organization will receive an email from Partners’ ShareFile system.
  3. Follow the instructions in the ShareFile email to create a password. Upload three Quality Improvement Projects by August 30, 2019 [No specific topics are required at this point].
  4. 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 regarding this requirement, please contact Tamikka Woods by calling 704-884-2568 or email twoods@partnersbhm.org.

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 ClaimsAs 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.

Medicaid—June 2019:   Number of Days to Process and Pay All Claims
Received Date to Paid Date: 8.1

Top Five Medicaid Claim Denials—June 2019

Claim Denial

Provider Recommended Action Steps

Invalid DCN (Document Control Number) or Resubmission Reference Number Review the RA (Remittance Advice) with the original claim number and make sure it was entered correctly.
Service is not authorized Verify Service Authorization for the consumer. Contact Utilization Management.
Duplicate Claim The claim has previously been submitted and adjudicated. Do not refile.
Claim received after the billing period Write off charges as non-billable. Do not rebill.
Billing Taxonomy submitted is not associated with billing NPI Rebill claim with correct taxonomy/NPI information.

Request for Qualifications: Surry County Professional Substance Use Disorder Intervention Team

Surry County, on behalf of the Surry County Opioid Response Director, invites interested agencies who provide substance use disorder treatment services to submit a Statement of Qualification for the formation and supervision of an “Intervention Team” to engage individuals with Substance Use Disorders (SUD) in Surry County at critical crisis junctures. Please view the Request for Qualifications Statement for details and submission information. Proposals are due no later than 5 p.m. on Monday, August 5, 2019. For a copy of the detailed RFQ, please contact Mark J. Willis, Surry County Opioid Response Director, Surry County Historic Courthouse, 114 W. Atkins St., PO Box 1467, Dobson, NC, 27017, phone: 336-401-8218, email: willism@co.surry.nc.us.

Social Determinants of Health

Food insecurity, housing instability, unmet transportation needs and interpersonal violence not only have a deep impact on a person’s health, safety and well-being, but also on healthcare utilization and costs.” These conditions are commonly called Social Determinants of Health. Social Determinants of Health are defined as the “conditions in which people are born, grow, live, work and age.”  Since 80-90% of a person’s health is connected to Social Determinants of Health it makes sense that being intentional about addressing Social Determinants of Health is leading to positive outcomes. One study revealed a 10% reduction in healthcare costs just by linking people served with needed social services. The University of Illinois Hospital reinvested funds to address housing insecurities which resulted in an 18% reduction in the average costs of those they served. A different study had a 25% reduction in repeat visits to primary care and in medication requirements for depression and addictions. Lastly, a pilot study resulted in a reduction in anxiety by simply linking people served with community resources.

Addressing Social Determinants of Health involves the following;

  • Selecting and implementing a tool to assess for Social Determinants of Health
  • Collecting member-level information related to Social Determinants of Health
  • Creating workflows to track and address member needs; and
  • Identifying social service resources and tracking linkages

If you would like to learn more about addressing Social Determinants of Health, please contact Allison Gosda at agosda@partnersbhm.org or call 828-325-4687.

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.

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)

DescriptionLevel 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, a 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 the 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)

DescriptionChild 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, a 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 the 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

Human Trafficking and Internet Safety – A Common Intersection 

Wednesday, September 18, 2019; 10 a.m.-12 p.m., Gastonia (Registration)

Description:  Human trafficking:  North Carolina has the eighth highest reported rate of human trafficking in the country. Learn how human trafficking can manifest in different ways, how to identify signs of labor and sex trafficking, and resources to help find support for trafficking victims.

Internet safety:  We live our lives connected to the internet, and while that can often be a benefit, it also carries major safety risks. Learn how to protect your personal and financial information online, manage your digital footprint, and navigate social media and other gaming and mobile apps.

Target Audience:  Providers, Members, and Community

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:

July 15, 2019 –Partners to No Longer Manage Basic Outpatient Services
July 12, 2019 – NC Medicaid Open Enrollment, Webcast
July 10, 2019 – Transition to Managed Care, Innovations Webinars
July 1, 2019 – Rutherford Transition Information

June 24, 2019 – Rutherford Transition SARs; Research Based-Behavioral Health Treatment; Partners Communications

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

Recent Joint Communication Bulletins:

  1. #J331 Fee for Service Rate Correction for Research-Based BH Treatment CPT Codes
  2. #J330 Approval of NC’s 1915 (b) Waiver and Concurrent 1915 (c) Innovations Waiver

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

Training, Announcements and Reminders

MARS Open House: Integrated Care of Greater Hickory will host an open house on Thursday, August 29 from 2:00 – 3:30 pm at ICGH’s location at 1228 North Flint St, Lincolnton, NC. Come learn more about Medication Assisted Recovery Services (MARS), which includes medication, counseling and peer support services for adults ages 18 and older who have an opioid use disorder and live in Lincoln and Gaston counties.  Services are funded through a SAMHSA grant awarded to Partners. To learn more about the MARS grant, please visit https://www.partnersbhm.org/mars/.

2019 Transition Age Youth Regional SummitThe North Carolina Healthy Transitions Initiative would like to invite you to the 2019 Transition Age Youth Regional Summit! Our goal is to unite various youth agencies and community partners throughout the state of North Carolina. This will be a wonderful engagement as we continue to develop solutions and resources to support our transition-age youth in:

  • Education
  • Employment
  • Housing
  • Overall quality of life

What to Expect:  Two days of exciting cross-collaboration with the voices of youth/young adults at the pulse of our work! We hope to strengthen and increase new partnerships within North Carolina as we focus on action steps to move our mission forward.

Dates, Time, and Locations:

Western Region:
August 7- 8, 2019, 10 a.m.-4 p.m.
UNC Asheville- Sherrill Center
1 University Heights
Asheville, NC 28004
Eastern Region:
August 14-15, 2019, 10 a.m.-4 p.m.
Wilson Community College
4608 Ward Blvd.
Wilson, NC 27893

Free Registration–Register at 2019TAYREGIONALSUMMIT

Questions about the summit? Email nchealthytransitions@gmail.com.

DATE CHANGE! 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 August 16, 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).

NC Emergency Solutions Grants Request for Application Now Available:  The purpose of this Request for Application (RFA) is to solicit applications from non-profits and local units of government who are interested in providing the NC Department of Health and Human Services (DHHS), Division of Aging and Adult Services (DAAS), Emergency Solutions Grants (ESG) services related to assisting individuals or families that are homeless or at-risk of becoming homeless.

The Division of Aging and Adult Service, NC DHHS will accept applications for ESG funding from Continuums of Care (CoC) and Balance of State CoC Regional Committees (herein referred to as Local Planning Area – LPAs). The applications will recommend non-profit or local government agencies for funding. Recommended agencies will contract directly with NC DHHS, Division of Aging and Adult Services, for funding or with a Fiscal Sponsor, who will then contract directly with NC DHHS_DAAS.

All prospective applicants are strongly encouraged to attend one of the in-person technical assistance sessions below, being offered by the NC ESG Office, to review and discuss the 2019-2020 NC ESG RFA:

Tuesday, August 13, 2019, 10 a.m.-2 p.m.:

Buncombe County Administration Bldg.
1st Floor Conf Rm
200 College St
Asheville, NC 38801

Registration Link: https://attendee.gotowebinar.com/register/3045426606909231885

Wednesday, August 14, 2019, 10 a.m.-2 p.m.:

United Way of Alamance County
220 E Front St
Burlington, NC 27215

Registration Link: https://attendee.gotowebinar.com/register/5990933595326033677

Thursday, August 15, 2019, 10 a.m.-2 p.m.:

Trillium Health Resources
201 W 1st
Greenville, NC 27858

Registration Link: https://attendee.gotowebinar.com/register/26077517083130637

The deadline for submissions is Friday, October 11, 2019, at 5:00 p.m. (All applications must be received, not postmarked by, the NC ESG Office, no later than 5:00 p.m., October 11, 2019).

RFA Application Documents are found on the NC DHHS_DAAS Grant Opportunities website located: https://www.ncdhhs.gov/about/grant-opportunities/aging-and-adult-services-grant-opportunities