Partners’ December Provider Webinar

Partners will host its next Provider Webinar on Wednesday, December 11, 2019. To register, please visit https://providers.partnersbhm.org/provider-webinars-forums/.

Provider Account Specialist Changes

Partners Provider Network Department recently restructured the role of its Provider Network Account Specialists and provider assignments have changed.

  • Providers delivering State-Funded and B3 services, along with those with an increased need of technical assistance, are assigned to specific account specialists.
  • All providers have access to account specialists through a helpdesk function. Providers can reach the Helpdesk by emailing pnas@partnersbhm.org or calling 877-864-1454.

Measurement Based Care

In Provider Communication Bulletin #96, Partners rolled out the implementation date for the use of Measurement Based Care tools as November 1, 2019. As we move towards the implementation date, we received feedback from the Provider Council to host a webinar devoted to this topic. Partners hosted a webinar regarding Measurement Based Care on Wednesday, October 2, 2019. To view the webinar recording or slide deck, please visit https://www.partnerstraining.org/training-library/.

Additionally, Partners wanted to provide clarification to the tools listed in the Communication Bulletin.  The tools are not all inclusive or a comprehensive list.  As was indicated in the webinar, there are several considerations in choosing the tool that you would like to implement. When selecting a tool, use validated tools. The below list are options to choose from, but not exhaustive.

If you have further questions, please email PNAS@partnersbhm.org.

Registration of Interest (ROI): NC Medicaid Community Support Team – Permanent Supportive Housing (ROI #1019-001)

Partners Behavioral Health Management (Partners) is initiating a Registration of Interest (ROI) to solicit responses from appropriately qualified in network organizations to determine interest in providing NC Medicaid Community Support Team – Permanent Supportive Housing services for eligible members in Partners catchment.

This ROI will also be used to identify current Partners’ Network Providers interested in and qualified to provide NC Medicaid Community Support Team – Permanent Supportive Housing services.  Organizations approved to become a CST provider must have capacity to perform the Community Support Team service along with the tenancy supports components.  Depending on the volume of responses, Partners will either select several providers to enroll or will issue a full Request for Proposal.

ROI #1019-001 offers an overview of Partners requirements and links for additional resources, and is located at https://providers.partnersbhm.org/request-for-services/. Please review the ROI and to be considered for provision of this service, please complete the required documents and submit by October 30, 2019. 

Please contact Lisa Jordan by emailing ljordan@partnersbhm.org with any questions.

Issuance of an ROI/RFI/RFP does not guarantee a financial award, nor does it indicate a commitment on the part of the issuer to pursue further contractual relationship.

Public Comment Period Reposted:  CCP 8A-6, Community Support Team

Clinical Coverage Policy 8A-6, Community Support Team, has been reposted for public comment. All comments should be sent to medicaid.public.comment@dhhs.nc.gov by October 25, 2019.

NC Medicaid Managed Care

Providers are reminded to frequently visit https://medicaid.ncdhhs.gov/providers to learn about events and access tools, the Provider Playbook and more to help transition to managed care.

Upcoming DHHS Provider Training:  How Beneficiaries Move Between the Standard Plan and BH I/DD Tailored Plan:  NC DHHS will host a webinar for providers and members to share information on how beneficiaries will move between the Standard and BH/IDD Tailored Plan. The webinar will be held on November 6, 2019, from 2 p.m.-3 p.m. Register here.

Contracting Deadline Nov. 15, 2019For inclusion in auto-enrollment, provider contracts must be signed and mailed to health plans no later than November 15, 2019. More information is available at: https://medicaid.ncdhhs.gov/providers/provider-contracting-health-plans

Carolina Complete Health Awarded Additional Region in Medicaid Managed CareThe North Carolina Department of Health and Human Services has expanded the regions awarded to Carolina Complete Health Inc. to serve as a prepaid health plan under the state’s transition to Medicaid managed care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.

DHHS and Carolina Complete Health Inc. have been working together to ensure the health plan is well-positioned to meet the state’s vision of providing a whole-person system of care that addresses both medical and non-medical drivers of health. As a provider-led entity governed by physicians, CCH brings a unique perspective to Medicaid managed care. The agreement resolves CCH’s contested case pending at the Office of Administrative Hearings.

“Our top priority is meeting the health care needs of the people we serve, while being good stewards of public resources. As a physician, I understand the unique perspective that providers can bring to the health insurance market,” said DHHS Secretary Mandy Cohen, M.D. “We look forward to our continued partnership.”

“Carolina Complete Health is proud to be one of DHHS’ partners in pursuing its transformative, whole-person centered system of care, and we are very pleased to have the opportunity to bring our provider-led health plan to region 4,” said Chris Paterson, CEO of Carolina Complete Health.

Added Bob Seligson, CEO of the North Carolina Medical Society, “Our physicians are committed to providing leadership and governance for Carolina Complete Health to ensure that providers continue to have a central role as DHHS partners in improving the health and well-being of North Carolinians.”

In addition to counties in regions 3 and 5, Medicaid beneficiaries in the following region 4 counties will now have the option to choose Carolina Complete Health Inc. as their health plan: Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren and Wilson.

Open enrollment for Medicaid managed care began in 27 counties in July. It will launch statewide on October 14. In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. Transforming North Carolina’s Medicaid program to managed care is the most significant change made since its inception.

Enrollment Broker Provider Directory UpdateEffective October 2, 2019, the Enrollment Broker Provider Directory will no longer support searching for providers by specialty. The “Select a provider specialty” feature is no longer available. It has been removed from both the “Find a primary care provider” page and the “Filter by” page. Users must search for a practice by geographic location and/or by practice name to ensure the most accurate results.

After the September changes, providers informed Medicaid that some specialties did not display the group/practices within that specialty type selected. For example, a pediatric group will not display as a result, if the user selects “pediatric” as the specialty. This is a direct result of the way groups/practices are required to enroll their specialty – i.e.: as either “Multi-specialty” or “Single-specialty” groups. To alleviate potential confusion, we removed the “specialty” filter until such time as we can address the underlying data issue.

Medicaid is currently working with the Enrollment Broker to ensure the specialty search feature effectively displays provider information. This functionality will be added back to the directory before the launch of Medicaid Managed Care on February 1, 2020.

Raise the Age in Effect December 1, 2019

Effective December 1, 2019, 16 and 17 year old individuals who commit crimes in North Carolina will no longer automatically be charged in the adult criminal justice system. In 2017, lawmakers raised the age of juvenile jurisdiction for nonviolent crimes to age 18, following years of research, study and education on this topic. The Raise the Age initiative became law only through a strong, bipartisan coalition of support from all three branches of government, law enforcement and advocacy organizations, which continues today.

All providers should be familiar with the changes that Raise the Age will bring. To learn more about Raise the Age, please visit https://www.ncdps.gov/our-organization/juvenile-justice/key-initiatives/raise-age-nc.

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—September 2019:   Number of Days to Process and Pay All Claims
Received Date to Paid Date: 9.3
Top Five Medicaid Claim Denials—September 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 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.
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.

NC DHHS Family First Provider Readiness Assessment Survey

NC DHHS is currently in the readiness assessment and planning phase of implementing the prevention provisions of the Family First Prevention Services Act. Family First gives states the option to use Federal Title IV-E funding for prevention services for children, parents, and/or kin caregivers. Prevention services include:

  • In-home, skill-based parenting programs – individual and family counseling, parenting skills and parent education
  • Substance abuse treatment and prevention provided by a clinician, and
  • Mental health treatment provided by a clinician.

Implementation of Family First offers several significant opportunities including:

  • Transforming the child welfare focus from foster care to prevention and increased family stability and well-being
  • Investing in evidence-based interventions
  • Applying a trauma responsive lens to the continuum of prevention services, and
  • Partnering across systems (mental health, substance use disorder, juvenile justice, early childhood, health, etc.) to align prevention efforts.

Your help is needed. Part of the overall assessment and readiness process includes understanding the service array across the state and determining what evidenced-based programs should be in the prevention plan to meet the needs of North Carolina’s children and families.

NC DHHS asks agencies to participate in a Provider Assessment Survey as part of North Carolina’s readiness and planning process for implementing key provisions of Family First. By participating in the survey, provider agencies will have an opportunity to impact the content and implementation of North Carolina’s Family First prevention plan. The Provider Assessment Survey should be completed by agencies that deliver parenting services, mental health, and/or substance use treatment.  It is designed to assess the current capacity across three domains. The three domains in the survey are:

  • Trauma informed approach
  • Evidence-based programs (EBPs), and
  • Continuous Quality Improvement and the use of data to inform decisions.

Providers are encouraged to review the survey. Respondents are encouraged to meet with your teams to review the instrument so that you can be oriented to the questions. The actual survey is web-based and will be completed online via a link that will be emailed to providers in a Provider Alert prior to the survey go-live date of October 22, 2019. The survey closes on November 5, 2019.

NC DHHS is offering two Instructional Webinars for the provider community before the web-based survey goes live. The webinars will provide an overview of the survey purpose and process, explain the domains of the survey, and answer any questions. You may participate in either session – it is not necessary to attend both. Participating in either of the Webinars is not required in order to participate in the survey however, we strongly encourage you to join us so that you can learn more about the survey and we can answer your questions.

  • Instructional Webinar Session 1: Friday, October 18, 2019, 1 p.m.-2p.m. EDT (Registration)
  • Instructional Webinar Session 2: Monday, October 21, 2019, 9 a.m.-10 a.m. EDT (Registration)

Please feel free to share this communication with fellow providers and encourage participation. If you have questions, please contact Alycia Blackwell Pittman at FFPSA@dhhs.nc.gov.

GLC CoC Hosting iCare Tour

The Gaston Lincoln Cleveland Continuum of Care (GLC CoC) is comprised of local organizations who work together to identify and eliminate housing barriers to permanent housing for residents of Gaston, Lincoln, and Cleveland counties. In recognition of National Hunger and Homelessness Awareness Week, the GLC CoC is organizing the iCare Tour to highlight the agencies that support those in need. The participants will have an opportunity to see some of the services provided to Gaston County residents through local non-profit agencies and hear the experiences of those who have benefited from the services provided. The iCare tour will be held on November 20, 2019, starting at Partners Auditorium at 7:45 a.m. and end at 12:30 p.m., with transportation provided. For registration information, please contact Bre Griffin at bgriffin@partnersbhm.org or 704-884-2514.

Partners Autism Services Learning Collaborative

Partners offers an Autism Services Learning Collaborative as an opportunity for providers of Research Based-Behavioral Health Treatment (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 October 29, 1:30 p.m.-3:30 p.m., Partners’ Board Room, 901 S. New Hope Rd., Gastonia, NC 28054

Who should attend? RB-BHT Providers, Clinical Directors/Supervisors, Board Certified Behavior Analysts, Quality Management staff. Representation from all 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.

Goals of this collaborative:

  • To expand the use of Evidence Based Practices in order to promote positive outcomes for children diagnosed with Autism.
  • 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

Please RSVP and send any questions to Sara Wilson at swilson@partnersbhm.org.

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.

Child and Family Team – 1 “An Introduction to Child and Family Teams:  A Cross-System Training from the Family’s Perspective” (Class Full)

Date, Time and Location:  Monday and Tuesday, October 23 – 24, 2019, 9:00 a.m. to 4:00 p.m.,
Catawba County Life Skills Facility, 3060 11th Avenue Dr. SE, Hickory, NC 28602

Description:  CFT 1 is a two-day experiential training (when you register, you are agreeing to attend both days) 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.

Trainers:  Kim Rhoads, MA, LCAS, and Jeanne Patterson, BA, QP, SOC

Community Training Coordinators, Partners Behavioral Health Management.

Please register by Friday, October 18, 2019

Provider Orientation

9:00 a.m. – 12:00 p.m., Gastonia:  November 7, December 5 (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 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.

Motivational Interviewing

Date, Time and Location:  November 7, 2 p.m.-3 p.m., Webinar (Registration)

Description:  Motivational interviewing (MI) has been demonstrated to increase engagement and recruitment in substance use services, especially in persons who are engaging in treatment for the first time. Clients are much more likely to agree to treatment (in cases when it is not mandated) if MI is used to collaborate on the development of treatment goals. Additionally, Motivational Interviewing is shown to increase retention for up to six months after initially entering treatment. After the six-month mark, the effects are much less dramatic, suggesting that the six-month mark is where people have decided that they either are or are not going to commit to treatment. It is vital to employ MI to both increase recruitment into medication assisted recovery programs and to retain clients during the first six months of treatment- a time period during which dropouts are the most likely to occur.  This one-hour presentation will emphasize MI and link it to retention, engagement and stigma information specific to substance use.  The training will encourage clinicians to utilize MI during assessments and to utilize it in face-to-face meetings during a person’s first six months of treatment. For management, training should encourage them to make MI agency policy for assessments and group/individual sessions.

Training Objectives

  • Summarize research associated with MI and recruitment/retention
  • Give broad examples of MI language that could be utilized during assessments and sessions. Encourage person-first language, close collaboration with clients in regard to goal setting (no cookie-cutter treatment plans), and the need for consistent “check-ins” with clients
  • Link MI practice with staff attitudes on engagement and retention.  Reinforce that MI practices intrinsically improve the client’s perception of staff attitudes
  • Encourage attendees to advocate for MI to be made standard practice within their own agencies (especially SU and MAT based service delivery.

Trainer:  Gary W. Walby, Ph.D., MSPH, MS, Complex Systems Innovations, LLC

To register for this training please email your name, agency name and email address to vanderson@partnersbhm.org  You must register by October 31, 2019 at 5:00 pm to receive the link to the webinar.

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:

October 2, 2019:  Medicaid Transformation Update: Statement of Interest, TCM Policy Paper
September 20, 2019: Revision to PCB #96: OOT Benefit Limit for State & Medicaid

Joint Communication Bulletins, which are issued by the NC Department of Health and Human Services, can be found at https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-abuse/joint-communication-bulletins-2019.

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

Training, Announcements and Reminders

Benchmarks Public/Private Behavioral Health Forum:  Benchmarks will host its Public/Private Behavioral Health Forum on Friday, October 25, 2019 at the Royal Banquet and Conference Center, 3801 Hillsborough St., Raleigh, NC Cost is $30 for members, $45 for non-members (lunch provided). To learn more, please visit https://www.benchmarksnc.org/public-meetings-seminars/. To register, please visit https://www.eventbrite.com/e/publicprivate-behavioral-health-forum-tickets-73573439137.

Benchmarks Member-Only Annual Dinner and Meeting will be held November 13 and 14, 2019 at the Grandover Resort and Conference Center, Greensboro, NC. Download the meeting flyer here. to learn more, please contact Paige Wiggs at 919-828-1864 or email pwiggs@benchmarksnc.org.

i2i Center for Integrative Health 2019 Conference and Exhibition “Transformation Today and Tomorrow”:  Registration is now open for the I2i Center for Integrative Health’s annual conference and exhibition, being held December 4-6 in Pinehurst, NC. To view conference offerings and to register, please visit https://i2icenter.org/events/conference/.