DATE CHANGE:  Partners’ Providers Council

Partners’ Provider Council will hold its monthly meeting tomorrow, Friday, November 22, 2019 at Partners-Hickory Regional Office Multipurpose Room, 1985 Tate Blvd. SE, Hickory NC 28602. Providers will meet from 9:30-10:30 a.m., and Partners’ employees will join the meeting from 10:30 a.m.-12 p.m. You can learn more about the Partners’ Providers Council by visiting https://providers.partnersbhm.org/provider-council/.

DATE CHANGE:  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/.

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 holidays and vacations
  • Type of funding and clients served (Medicaid or State)

Providers should upload appointments for the next month at least two weeks prior to the beginning of the month. In addition, please inform Access to Care if you are adjusting hours due to operational changes.

If you have any questions, please contact Access to Care at 1-888-235-4673.

Partners Conducts Annual Member Mailing

Over the next week, our members (people receiving services through Partners) will receive a letter reminding them of what we do and how we can help.

Each year, Partners mails a letter to everyone enrolled in our health plan. This is a requirement of our contract with the Division of Health Benefits. Approximately 33,000 people receiving intellectual/developmental disabilities, mental health, and/or substance use disorder services over the past 12 months will get the letter. We encourage our providers to check out, and direct members, to our member resources at https://www.partnersbhm.org/resources/. Members with questions or wish to receive printed resources may contact Partners’ Member Engagement Department at 1-877-864-1454 and select option 7.

Behavioral Health Screening and Self-Help Tools

Partners wants members to have the best overall health they can have. To assist our providers in providing this care, we have Confidential Screening and Self-Help Tools available at on our website, www.partnersbhm.org. These tools can help a member identify how they are feeling and serve as a starting point for a conversation with their Provider. Screening tools are intended to be for informational purposes and do not take the place of a diagnosis by a professional. The screening tools can be accessed on the Partners’ website by clicking Confidential Screenings under the Member tab on the home page.

NC-TOPPS Access Control Process Implementation

Partners has implemented a new process for NC-TOPPS Access Control that is twofold as it relates to provider staff gaining access to NC-TOPPS System and termination of access to the NC-TOPPS System:

Gaining Access to the NC-TOPPS System

  • Partners Quality Management (QM) will continue to provide new provider staff (SuperUsers) with access to the NC-TOPPS System
  • SuperUsers will continue to manage Qualified Professionals (QPs) and Data Entry User (DEUs) staff access through the NC-TOPPS System
  • Partners’ will continue to provide technical assistance to providers as needed for this process

Termination of access to NC-TOPPS System

  • Provider SuperUsers will manage the termination of QPs and DEUs staff at their agencies.
  • All non-active staff [staff who are no longer employed or have not been in the NC-TOPPS System within 45 days
  • Partners will provide technical assistance as needed to providers with terminating of access to the NC-TOPPS System of their staff as needed
  • SuperUsers for each NC-TOPPS service provider will receive an email from Partners QM Department quarterly with the list of current staff with access to the NC-TOPPS System.
  • The Super User needs to respond to the email with the updated information on staff continued need for access to the NC-TOPPS System

Please email nc-toppsquestions@partnersbhm.org if you have any questions.

NC HealthConnex Connectivity Requirements

All health care providers who receive state funds (e.g., Medicaid, NC Health Choice, State Health Plan, etc.) for the provision of health care services must connect to NC HealthConnex by specific dates in 2018, 2020 and 2021 to continue to receive payments for services provided (NCGS § 90-414.4).

Specifically:

  • Hospitals, physicians, physician assistants and nurse practitioners who provide Medicaid services and who have an electronic health record system must connect by June 1, 2018.
  • Local Management Entities/Managed Care Organizations (LMEs/MCOs) are required to submit encounter and claims data by June 1, 2020.
  • Ambulatory surgical centers, dentists, licensed physicians whose primary area of practice is psychiatry, and the State Laboratory of Public Health operated by the Department of Health and Human Services must submit demographic and clinical data by 2021.
  • Pharmacies and State health care facilities operated under the jurisdiction of the Secretary of the Department of Health and Human Services must submit claims data by June 1, 2021.
  • Providers who do not receive state funding for the provision of health care services may also connect to the NC HIEA on a voluntary basis to support whole-person care.

For additional details and to remain current on state connectivity requirements for your practice, please visit https://hiea.nc.gov/.

Utilization Management Updates

Clarification of State-Funded Inpatient Benefit Limits:  Partners Utilization Management would like to clarify that benefit maximums for State-Funded (Non-Medicaid) Service Authorization Requests are:

  • YP820 and YP821: Initial, up to seven days; Concurrent, up to seven days
  • YP821SA: Initial, up to four days; Concurrent, up to seven days
  • YP822 and YP822SA: Initial, up to three days; Concurrent, up to three days

Medicaid as Secondary InsurancePartners Utilization Management would like to remind providers to check all insurance funding sources for members seeking services. When submitting Service Authorization Requests (SARs) for members with private insurance and/or Medicare, in addition to Medicaid, please document the purpose of the Medicaid SAR (i.e. Exhaustion of Benefits, Medicaid Copay) and provide any supporting documents. Effective August 1, 2019, Partners UM Reviewers began contacting providers for this information if it was not provided.

Holiday Inpatient SAR Submissions:  Hospitals in the Partners Network are responsible for recongizing the number of days authorized and determining when the next review is due for the following codes:

  • Initial Medicaid (0101) and State Funded (YP820) Service Authorization Requests (SARs) can be submitted within 48 hours of admission.
  • Three-Way SARs can be submitted within three calendar days of admission.
  • Continued stay SARs require prior authorization.

Partners Utilization Management Acute Services team members will be available daily from 8 a.m.-7 p.m. during the holidays. To coordinate with hospitals in reviewing Inpatient requests, SAR submission guidelines have been modified during the Partners’ November holiday (Thursday, November 28 and Friday, November 29, 2019). SARs with a start date of Thursday, November 28, 2019 can be requested for up to four days (requesting Thursday, Friday, Saturday and Sunday).

Partners’ December holiday is scheduled for Tuesday, Dec. 24, Wednesday, December 25, and Thursday, December 26, 2019. We ask providers to keep these dates in mind when determining when SARs should be submitted. Units and timeframes requested may need to be adjusted to stay within benefit maximums.

Providers can contact the Acute Services Team at 704-842-6434.

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.

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 the 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

Audit Type Result Finding
Timeliness of Provider Payments (within 30 days) 99.99% Compliant
Claims Processing Accuracy 100% Compliant
Financial Accuracy 99.97% 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.

Oct. 2019:  Medicaid—Number of Days to Process and Pay All Claims

Received Date to Paid Date: 9.1

Top Five Medicaid Claim Denials for Oct. 2019

Claim Denial

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 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.

NC Tracks News—DHHS Suspends Implementation of Managed Care

A Message on Behalf of NC Medicaid

While this year’s legislative session was one of the longest in recent memory, it ended without needed action required for managed care to move forward. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Therefore, the Department of Health and Human Services will be suspending managed care implementation and open enrollment. Managed care will not go live on February 1, 2020.

With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Behavioral health services will continue to be provided by Local Management Entities – Managed Care Organizations. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks.

The Medicaid Managed Care Call Center (833-870-5500) will stay open through the scheduled open enrollment period to answer questions but will no longer enroll beneficiaries in a health plan. Beneficiaries can continue to contact the Medicaid Contact Center (888-245-0179). Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans.

The suspension of work and the wind-down process will begin today. Once suspended, managed care cannot easily or quickly be restarted. The Department will not decide on a new go-live date until it has program authority within a budget that protects the health and safety of North Carolinians and supports the Department’s ability to provide critical oversight and accountability of managed care.

Both the conference and transformation mini budgets passed during this year’s legislative session and vetoed by the Governor left the department vulnerable to an unprecedented cut that would have had a crippling effect on its ability to provide services that protect people’s health and safety and moved the Department out of Raleigh to Granville County. In addition, neither expanded Medicaid so that hardworking North Carolinians could afford access to health coverage.

The Department is committed to doing its best to mitigate the inevitable confusion for beneficiaries and our many partners.

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

Date, Time and Location:  9:00 a.m. – 12:00 p.m., Gastonia:  December 5 (click 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.

Community Training

Child & Family Team Training Part 1—An Introduction to Child & Family Teams: A Cross-System Training from the Family’s Perspective (Registration)

Date, Time and Location:  Thursday, January 9 and Friday, January 10, 2020, 9 a.m.-5 p.m. (both days)

Catawba County Life Skills Facility, 3060 11th Avenue Drive SE, Hickory, NC 28602

Description:  CFT 1 is a two-day experiential training (when you register, you are agreeing to attend both days) with the goal of providing an overview of Child & Family Team meetings from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing Child & Family Teams through the lens of multiple systems. Participants must attend both days in entirety to receive training credit.

Trainers:  Kim Rhoads, MA, LCAS, Community Training Coordinator, Rhonda Baylor, Family Partner

Register by Friday, January 3, 2020

Child & Family Team Training Part 1—An Introduction to Child & Family Teams: A Cross-System Training from the Family’s Perspective (Registration)

Date, Time and Location:  Wednesday, January 15 and Thursday, January 16, 2020; 9 a.m.-5 p.m. (both days)

Partners Gastonia Auditorium, 901 S New Hope Road, Gastonia, NC 28054

Description:  CFT 1 is a two-day experiential training (when you register, you are agreeing to attend both days) with the goal of providing an overview of Child & Family Team meetings from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing Child & Family Teams through the lens of multiple systems.

Trainers:  Jeanne Patterson, Community Training Coordinator, Casey Pruitt, Lead Family Contact – SAMHSA Grant

Please register by Thursday, January 9, 2020

Mental Health First Aid (Registration)

Date, Time and Location:  Thursday, December 5, 2019, 8:30 a.m.-5 p.m., Partners-Hickory Multipurpose Room, 1985 Tate Blvd. SE, Hickory NC

Description:  Mental Health First Aid teaches you how to identify, understand and respond to signs of mental illnesses and substance abuse disorders. This 8-hour training gives you the skills you need to reach out and provide initial support to someone who may be developing a mental health or substance use problem and help them connect to appropriate care.

Trainer:  Jeanne Patterson, Community Training Coordinator

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:

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.

Special Medicaid Bulletin: Medicaid Bulletin Holiday Posting Schedule

The NC Division of Health Benefits has published a Special Medicaid Bulletin, Medicaid Bulletin Holiday Posting Schedule, dated November 13, 2019. Providers are encouraged to review this important information. For details, please refer to the 2019 Medicaid Bulletin web page.

New Medicaid Bulletin Articles Now Available

The NC Division of Health Benefits has published three Medicaid Bulletin articles dated Nov. 12, 2019:

  • Clinical Coverage Policies
  • Updated ICD Diagnosis Code List
  • Enrollment for CAP/DA Direct Service Informational Webinar

Providers are encouraged to review this important information at https://medicaid.ncdhhs.gov/providers/medicaid-bulletin.

Training, Announcements and Reminders

NAMI Lake Norman/Iredell hosts the following support groups for the community. To learn more, visit www.namilakenormaniredell.org. You can contact NAMI Lake Norman/Iredell by calling 704-236-2264.

NAMI Connection Recovery Support Group is a free, peer-led support group for adults living with mental illness. You will gain insight from hearing the challenges and successes of others and the groups are led by NAMI-trained facilitators who’ve been there. NAMI’s Support Groups are unique because they follow a structured model to ensure you and others in the group have an opportunity to be heard and to get what you need.

NAMI Connection is held:

  • Statesville: First Saturday of the month, from 2:00-3:30 p.m. at Fifth Street Ministries, 1421 5th St, Statesville, NC 2867.
  • Huntersville: Third Monday of the month, from 6:30-8:00 p.m. at Huntersville United Methodist Church, 14005 Stumptown Rd., Huntersville, NC 28078.

Registration is not required for either group. To learn more, visit http://www.nami.org/Find-Support/NAMI-Programs/NAMI-Connection.

NAMI Family Support Group is a free, family-led support group for family members who have relatives living with mental illness. You will gain insight from hearing the challenges and successes of others and the groups are led by NAMI-trained facilitators who’ve been there.

NAMI Family Support Group is held:

  • Statesville: First Saturday of the month, from 2:00-3:30 p.m. at Fifth Street Ministries, 1421 5th St, Statesville, NC 2867.
  • Huntersville: Third Monday of the month, from 6:30-8:00 p.m. at Huntersville United Methodist Church, 14005 Stumptown Rd., Huntersville, NC 28078.

Registration is not required for either group. To learn more, visit http://www.nami.org/Find-Support/NAMI-Programs/NAMI-Family-Support-Group or

NAMI South Mountain Classes and Groups:  The following classes and groups are offered by NAMI South Mountains, serving Burke, Cleveland, Lincoln and Rutherford counties.

Family-to-Family Educational ClassesIf you have a family member or other loved one with a history of mental illness, please attend our 12-week educational class. We help you gain a better understanding of mental illness and how to communicate with your loved one, his or her psychiatrist, and other family members. At no cost to you, our class will tell you what questions to ask the psychiatrist and how to build a stronger relationship with your loved one.

NAMI Family to Family
Jan. 11-May 28, 2020
Sat 10:30 a.m.-1:00 p.m.
Emmanuel Lutheran Faith Building
209 S. Government St. Lincolnton, NC 28092

Peer-to-Peer Educational Classes:  NAMI Peer-to-Peer is a free, 10-session educational program for adults with mental illness who are looking to better understand their condition and journey toward recovery. Taught by a trained team of people who’ve been there, the program includes presentations, discussion and interactive exercises. Everything is confidential, and NAMI never recommends a specific medical therapy or treatment approach

NAMI Connections:  This support group is for those who are struggling with mental illness and facilitated by a trained individual who also struggles. This group is interactive and will address struggles with obtaining community support, communicating with loved ones, and developing positive responses to ones illness.

NAMI Connection Veterans Support Group-Burke
Every other Saturday, 2:30 p.m.-4:30 p.m.
VFW Table Rock Post #5362
520 Hopewell Rd., Morganton, NC 28655

NAMI Connections Support Group
Every other Saturday, 2:00 p.m.-3:00 p.m.
Phoenix Counseling Center
2505 Court Drive, Gastonia, NC

Connections Support Group
Every other Saturday, 1:00 p.m.-2:00 p.m.
Ollie Harris Behavioral Health Center
200-2 S. Post Rd., Shelby, NC 28152

Connections Support Group
Every other Thursday, 5:00 p.m.-7:00 p.m.
Ollie Harris Behavioral Health Center
200-2 S. Post Rd., Shelby, NC 28152

NAMI Family SupportThis group offers the opportunity for family members to process their struggles in supporting their loved ones. Issues like communication, boundaries, medical compliance are addressed. This group is about interactive support.

NAMI Family Support Group
Every Third Tuesday at 6:30 p.m.
Emanuel Lutheran Faith Building
206 Government St. Lincolnton, NC
Helpline 1-828-771-6305

NAMI Family Support Group
Second Tuesday of each month, 7:00 p.m.-8:30 p.m. (They ask to please be on time)
Lincoln County YMCA (Gaston Street. Location)
Any questions please email missy.nami.lincolncounty@gmail.com with subject: FGS or call 704 740-5745.

Family Support Group
Every other Tuesday, 5:30 p.m.-7:00 p.m.
Peace Mental Health Community Center
124 S. Powell St., Suite D, Forest City, NC