Partners Awarded BH I/DD Contract

Partners Health Management (Partners) has been contracted to operate a North Carolina Behavioral Health and Intellectual/Developmental Disability (Behavioral Health/IDD) Tailored Plan as part of the state’s transition to Medicaid Managed Care.

Behavioral Health/IDD Tailored Plans will integrate under one health plan. physical health, mental health, intellectual/developmental disabilities, traumatic brain injury and pharmacy services for North Carolinians with the most complex needs.

“We are honored to have been selected as one of the organizations to receive a NC Behavioral Health/IDD Tailored Plan contract today. Integrating health care services for our members under one plan will allow us to further build on our mission of Improving Lives and Strengthening Communities,” said Partners CEO Rhett Melton.

Under the current system, Medicaid services for behavioral health and I/DD for individuals with complex needs are managed by Local Management Entities/Managed Care Organizations (LME/MCOs) like Partners. Currently, physical health and pharmacy services for individuals with more complex needs are managed by the North Carolina Department of Health and Human Services (DHHS) under a fee-for-service model (NC Medicaid Direct).

The Behavioral Health/IDD Tailored Plans will provide the same services as NC Medicaid Standard Plans, which launched on July 1, 2021 but will offer additional specialized services for individuals with significant more complex needs, including those using 1915(c) Home and Community-Based Services waivers and State-funded Services.

In 2020, NC Medicaid issued a Request for Applications (RFA) to all LME/MCOs. Partners submitted its response to the RFA in February and was awarded one of seven four-year contracts by the state today. NC DHHS and the federal Centers for Medicare & Medicaid (CMS) approved the contract awards.

Partners will continue to serve members with significant behavioral health disorders, I/DD and traumatic brain injuries under NC Medicaid Direct until the BH I/DD Tailored Plans launch in 2022.

Innovations Community Living and Supports Authorization Transfers

Effective August 16, 2021, Partners Innovations Waiver authorizations for Community Living and Supports (T2013TF) will be transferred to a new service definition to encompass new Electronic Visit Verification (EVV) codes. I/DD Utilization Management (I/DD UM) will transition the authorizations.

Providers will see a new authorization in the system for the Community Living and Supports definition for “ALL Services” code. This new authorization will allow the provider to choose to bill the appropriate EVV code as needed. Units on the new authorization will be prorated based on the current authorization. Providers should still provide the service in accordance with the member’s approved Individualized Support Plan (ISP) as failure to do so may result in a recoupment. Please be reminded that authorization is not a guarantee of payment.

If there are issues with the new authorization, please contact the I/DD UM workgroup at 704-884-2605.

Important Update about Electronic Visit Verification

Please note the following information, related to Grouped Service Codes (“ALL Service Code”) in HHAeXchange.

Several LME/MCOs have grouped service codes within one authorization for members to avoid sending multiple authorizations for members being serviced in the home versus in the community.

What is expected from providers: Do not schedule or confirm a visit with the “ALL” service code. When scheduling or confirming a visit, providers must select the appropriate service code and modifier combination that represents services being provider prior to billing.

  • Please note that any visit scheduled with a service code that is not covered by the authorization will display as PINK on the member’s calendar. Since the service code on the visit will not match the service code on the authorization, these visits will always be PINK. This does NOT stop you from billing as authorizations are not required for billing.

If you have further questions, please visit https://hhaexchange.com/nc-lme/ for helpful resources and training or contact HHAeXchange Client Support at ncsupport@hhaexchange.com.

County Realignment Updates

Providers currently serving members Cabarrus, Union and Stanly counties that are not contracted with Partners or have questions about the contracting/credentialing process should email PAS@partnersbhm.org.

Partners Requesting Unmanaged Authorization Information:

On September 1, 2021, Partners will assume the Utilization Management functions for behavior health services provided in Cabarrus, Union, and Stanly counties. Partners Utilization Management will enter all authorizations needed for members in order to eliminate any undue administrative burden onto providers. However, we need your assistance to do so.

Partners will receive information about all authorizations that have been issued as of August 31, 2021.Partners has been given information about all authorizations that have been issued up to August 31, 2021. However, it is important that we have information about any b(3), State-Funded, or Medicaid services that may not have required an authorization with Cardinal, but do require an authorization with Partners. These services include: 

  • B3 Supportive Employment – Individual
  • Medicaid-Multi- Systemic Therapy (MST)
  • State/Medicaid – Substance Abuse Intensive Outpatient Program (SAIOP) Adults and Adolescents
  • State/Medicaid – Substance Abuse Comprehensive Outpatient Treatment Program (SACOT)
  • State/Medicaid – Non-Hospital Medical Detox
  • State- Individual Placements and Supports- IPS SE – Individual
  • State- Transition Management Services
  • State- Facility Based Crisis – Adults
  • State- Family Living Low

Providers are asked to complete the Unmanaged Authorizations Spreadsheet available at https://providers.partnersbhm.org/wp-content/uploads/20210818-county-realignment-unmanaged-services-spreadsheet.xlsx  and return (via encrypted email) to Jen Gennerman at jgennerman@partnersbhm.org.

Partners encourages providers to continue to deliver service at the same frequency as members received on August 31, 2021.

If you have questions, please contact Charity Bridges, Utilization Management Director by emailing cbridges@partnersbhm.org or calling 704-884-2637.

Service Code Crosswalk: Partners Utilization Management (UM) has developed a Cardinal/Partners Service Code Crosswalk to assist providers with the seamless transition of services to members in Cabarrus, Stanley and Union counties. We encourage providers to use the crosswalk as a resource when requesting Service Authorization Requests (SAR) and/or submitting claims to Partners beginning September 1, 2021. The Service Code Crosswalk is available at https://providers.partnersbhm.org/cardinal-partners-service-code-crosswalk/ and accessible from the Quick Nav section on the Partners Provider Knowledge Base homepage.

Upcoming webinars, as well as recordings of previous events, can be found at https://www.partnersbhm.org/county-realignment/#provider-events.

Other County Realignment resources:

AMH+ and Care Management Agency Survey

Partners is seeking additional information from providers in regard to Advanced Medical Home + and Care Management Agency implementation. We have previously requested information and appreciate all who took the time to respond.

As we move toward operating a BH I/DD Tailored Plan, we would like to gain detailed information on how we might support you through this process. Please complete this brief survey to help us understand how Partners might be able to support you and your care management efforts.

Reminder – Perception of Care Survey

Providers selected to participate in the 2021 Perception of Care Survey should use the link in the email sent from Partners to enter the data collected from members. Providers are asked to complete at minimum, 15 surveys for each population group (Adult, Youth, Child and Family). The submission link will be open until September 13, 2021 unless the state extends the time frame.

If you typically participate in the Perception of Care survey and have not received an email from Partners, please check your spam/junk folders and reach out so that we can ensure that the information is received. The same provider staff contact email was used this year unless informed of a change in persons responsible for this activity.

If you have any questions about this year’s survey, please email Bill Rankin, brankin@partnersbhm.org or respond to the email sent from Quality Management staff. Thank you in advance for your attention.

Claims Information

Explanation of Benefits, Requests for Coordination of Benefits Claims: As a reminder, Partners does request copies of the Explanation of Benefits (EOB) for members/claims submitted indicating Coordination of Benefits. The request will originate via email from Partners’ Claims Department. 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.

Reminder: Taxonomy Code 193200000X: Taxonomy Code 193200000X should not be submitted on claims as the rendering taxonomy code. All claims submitted with this taxonomy code as the rendering code will be reverted.

July 2021: Medicaid—Number of Days to Process and Pay All Claims
Received Date to Paid Date: 9.1

 

Top Five Medicaid Claim Denials for July 2021

Claim Denial

Provider Recommended Action Steps

Duplicate claim. The claim has previously been submitted and adjudicated. Do not refile.
Referenced claims has already been resubmitted. Multiple resubmissions not allowed. This is for replacement or reversed claims. The original claim being referenced has already been resubmitted. Please review for possible submission errors.
Claim received after billing period. Write off charges as non-billable. Do not rebill.
Service is not authorized. Verify Service Authorization for consumer/member. 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 LME/MCO for further assistance.

 

Reminders:

State News and Updates

BH I/DD Tailored Plan Contract Announcement: Partners was one of seven organizations announced by the North Carolina Department of Health and Human Services to serve as a Behavioral Health and Intellectual/Developmental Disability Tailored Plan. Read the announcement:

https://www.ncdhhs.gov/news/press-releases/2021/07/26/ncdhhs-announces-medicaid-managed-care-regional-behavioral-health-idd-tailored-plans

NC Medicaid Managed Care Update: With the launch of NC Medicaid Managed Care on July 1, 2021, NC Medicaid is offering updated guidance for Medicaid providers on a variety of topics around provider claims, prior authorizations, provider contracting and other topics. Updates include Managed Care Claims and Prior Authorization Submission Fact Sheets that give Claims Submission Guidelines and Resources (Part 1) and Frequently Asked Questions and a PHP Claims Schedule (Part 2). These Fact Sheets are posted in the Provider Playbook.

Partners has posted FAQs from recent Transition of Care webinars on its website at https://www.partnersbhm.org/medicaid-transformation-update/#for-providers.

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

Medicaid Bulletins: All bulletin articles, including those related to COVID-19, are available on the DHB webpage. Providers are encouraged to review this information.

NCTracks: Providers are encouraged to review NCTracks communications. To subscribe to NCTracks communications, visit https://www.nctracks.nc.gov/content/public/providers/provider-communications.html.

Upcoming Provider Meetings and Training

Partners’ Provider Council: The Partners’ Provider Council is a professional representative 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. Meetings are held on the fourth Friday of the month.

This month’s meeting will be held on Friday, Aug. 27, 2021. Providers will meet beginning at 9:30 a.m.; Partners staff will join at 10:30 a.m. Click here to register.

Provider Open House

Sept. 2, 2021, 9 a.m.-11 a.m., online (Register)

Join Partners’ Provider Network, Claims, Access to Care, Utilization Management, Care Management and Quality Management staff for an interactive information session. This open-house style event will allow each attendee time to work one-on-one with Partners’ staff to discuss any issues, questions or unfamiliar topics.

Quarterly Provider Webinar: Join us for Partners Quarterly Provider Webinar on Sept. 8 from 1-3 p.m. Updates and vital information will be shared with providers. Register here.

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/.

Provider Training: Register in advance at www.PartnersTraining.com. If you have any questions about provider-focused trainings, please email training@partnersbhm.org. All trainings and events are free to registered attendees. Find more training opportunities at www.partnersbhm.org/event-calendar/

Partners’ Training Library: Are you looking for a recent presentation from a previous Partners’ Training Academy event? Our on-demand training library is available as a resource in the Partners Training Academy. Presentations are listed in chronological order, from newest to oldest. Find slide decks, tip sheets and video tutorials. https://www.partnerstraining.org/training-library/

New to the Partners Training Library: Housing Tutorials

Partners has added three brief tutorials (less than 30 minutes) that are available on demand viewing.  They are a great resource for new staff or for those wanting a refresher. Check them out at https://www.partnerstraining.org/training-library/.

Children With Complex Needs/Dual Diagnosis Forum

Multiple Sessions, 1:30-3:30 p.m. (Register)

Partners Health Management would like to invite ALL providers who are serving dually diagnosed members or who would like to serve dually diagnosed Individuals (Children and Adults) with Intellectual and Developmental Disabilities, including Autism, Mental Health Disorders and are at risk of not being able to return or maintain placement within the their communities to join us for a NEW CWCN/Dual Diagnosis Provider Forum the second Fridays of each month, beginning Sept. 10, 2021, 1:30-3:30 p.m. and continuing for the remainder of FY 2021-2022.  Meeting dates are as follows:

  • 10, 2021, 1:30-3:30 p.m.: MH Approaches to I/DD, Module 1 – What is Dual Diagnosis?
  • 8, 2021, 1:30-3:30 p.m.: Module 2 – Understanding Assessment Practices in Dual Diagnosis.
  • 12, 2021, 1:30-3:30 p.m.: Module 3 – Mental Health Evaluations.
  • 10, 2021, 1:30-3:30 p.m.: Module 4 – Signs and Symptoms of Mental Illness.
  • 14, 2022, 1:30-3:30 p.m.: Module 5 DM-ID to DM-ID 2.
  • 11, 2022, 1:30-3:30 p.m.: Module 6 – Support Strategies.
  • March 11, 2022, 1:30-3:30 p.m.: Module 8 – Childhood and Adolescence.
  • April 8, 2022, 1:30-3:30 p.m.: Module 9 – Aging..
  • May 13, 2022, 1:30-3:30 p.m.: Conduct disorder, intermittent explosive disorder, and impulse control disorder in members with ID, developmental disorders.

Please mark your calendars and plan on attending these important Workforce Development sessions.

Areas of monthly business will focus on:

  • NADD membership, certifications, reimbursed preparation study time for provider staff
  • Workforce Development Activities and Staff Competencies
  • NADD and NC START Training opportunities /Learning Collaboratives
  • Quarterly State Reporting Requirements/Updates
  • Contract Requirements and Monitoring, Value Based Contracts
  • Member Data, Metrics and Outcomes (POMs, NCI) being established/standardized
  • Quality Assurance and Quality Improvement Activities (Quality of Care, Quality of Life)
  • Family Impact, Health Disparities, Transitions Across the Lifespan
  • EPSDT options (supported by research)
  • Best Practices (supported by research)
  • Barriers to accessing services/Service gaps
  • Assessment/Evaluation – “knowing what we are treating, to treat appropriately”
  • Advocacy – Member/Family/Stakeholder Education
  • Communication, Assistive Technology
  • Conflict Resolution
  • Networking, Brainstorming

Should you have questions, or need additional CWCN/Dual Diagnosis information, please feel free to contact Cheryl Smith (csmith@partnersbhm.org), Michelle Stroebel (mstroebel@partnersbhm.org) or Doug Gallion (dgallion@partnersbhm.org) at Partners Health Management. Partners looks forward to working with each of you on improving individual’s lives and strengthening community resources, through this forum.

CST Service Definition Webinar
August 24, 8:30 a.m. – 11:45 a.m. (Register)

The CST Service Definition training is a recorded webinar training that will offer registrants basic knowledge needed to learn of the changes to the Community Support Team service definition, including additional responsibilities for permanent supportive housing and UM requirements. There are two breaks during this recorded training. Participants will be required to pass a 10 question quiz at the conclusion of the webinar.  This course does not offer NBCC credits.

CBT Learning Community

Sept. 15, 2021, 2 p.m.-3:30 p.m. (Register)

Join likeminded providers in a learning community to explore skills, concepts, case studies, and expand your own techniques. This learning community will you learn practical ways to use evidence-based practices in your day to day work with members. The CBT Learning Community is not approved for NBCC CEs.

What do we do in this learning community?

  • Assist with self-care.
  • Reduce burnout.
  • Foster professional growth and connection to a community.
  • Explore evidence-based practices.
  • Gain a sense of mastery.
  • Invest in your emotional bank account
  • Assist in improving in the quality of care delivered
  • Learn and practice reimbursable skills.

Permanent Supportive Housing (PSH)

Sept. 14, Sept. 16, Sept. 21, and Sept. 23, 2021, 8 a.m.-12:30 p.m., online (Register)

Partners has scheduled a series of virtual trainings on the evidence-based model for Permanent Supportive Housing (PSH). With the policy change, CST providers are to offer ongoing, tenancy support services. This training will support ANY provider by improving their understanding and practice of the PSH model. Experienced and certified PSH trainers from the Technical Assistance Collaborative (TAC) have created the training. These sessions will be facilitated by TAC trained Partners’ staff. This is a virtual live event; you will need to participate using audio and video capabilities. If you cannot access audio and video, you will need to wait to take a face-to-face class. If you are not participating by video, you will be removed from the session. You must attend all four sessions of training to receive credit.

Trainers: Carolyn Shoaf and Michelle Stroebel, Partners Health Management

Target Audience: All CST staff members (15 hours of Tenancy Support Training must be completed within 90 days of hire. This training meets that requirement), ACTT, TCLI, and any housing staff.

Cognitive Behavioral Therapy Foundations

Sept. 15 and Sept. 17, 2021, 9 a.m.-12:15 p.m. (Register)

Cognitive Behavioral Therapy (CBT) is an evidenced-based practice focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. This is a virtual live event, you will need to participate using audio and video capabilities. If you cannot access audio and video you will need to wait to take a face to face class. If you are not participating by video you will be removed from the session. This training is for 2 (3 hour sessions) on 9/15 and 9/17. You must attend both trainings to receive credit. No partial credits will be given.
NCSAPPB and NBCC approval for up to 6 hours.
Partners has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6932. Programs that do not qualify for NBCC credit are clearly identified. Partners is solely responsible for all aspects of the programs.
Trainer: Eric Ottinger

 PIP/QIP 101 Training for Providers
Sept. 29, 2021, 9-11 a.m. (Register)

This course will review the key components for developing a new Performance Improvement Project/Quality Improvement Project (PIP/QIP), tracking data, analyzing results and implementing change. Review requirements. Practice a “test” project. This will be a live training using the Zoom platform. Registrants will receive the zoom link via email the day prior. This course does not offer NBCC CEs.

PIP/QIP 102 Training for Providers

Sept. 29, 2021, 1-3 p.m. (Register)
This course will review strategies for how to best manage a PIP/QIP once started. Class will provide practice of analysis and determining next steps to improve outcomes. This will be a live training using the Zoom platform. Registrants will receive the zoom link via email the day prior. This course does not offer NBCC CEs.

Person-Centered Planning Instructional Elements

Sept. 30, 2021, 8:30 a.m.-12:15 p.m. (Register)

This course will meet the requirement for three hours of training for Person-Centered Planning (PCP) Instructional Elements. The training covers documentation requirements for both PCPs and Crisis Plans. All providers are invited, especially those that write PCP and Crisis plans. Individual pre-registration is required. Maximum capacity is 40 participants. This course does not offer National Board of Certified Counselors (NBCC) Continuing Education credits.

Crisis Response Training

Oct. 7, 2021, 1-3:30 p.m. (Register)

Crisis Response Training is an interactive class reviewing best practices, requirements and strategies for providers. Instruction covers content for before, during and after crisis episodes. This course will be held in a virtual format. The zoom link will be provided on October 6 via email. This course does not offer National Board of Certified Counselors (NBCC) Continuing Education credits.

 Housing Assessment as a Tool for Success

Oct. 14, 2021, 8:30-10:30 a.m. (Register)

Providers striving to successfully house members benefit from using validated assessment tools. This training covers why validated tools add value to the process. Review of the Partners specific tool will also be provided, along with a skills review for scoring and application of results. This course does not offer National Board of Certified Counselors (NBCC) Continuing Education credits.

Goal Writing for Plans of Care

Oct. 19, 2021, 1:00-4:30 p.m. (Register)

This training is for providers who are new to writing goals for plans of care.  Will review the purpose and structure of goal writing, the difference in goals v/s objectives, and common mistakes.  Registrants will have time to practice writing goals during the session. This course does not offer National Board of Certified Counselors (NBCC) Continuing Education credits.

LOCUS

Oct. 20, 2021, 8:30 a.m. – 12:30 p.m. (Register)

Providers are required to use the LOCUS clinical tool to evaluate and determine the level of psychiatric and addiction services care needed for adults.  This training is conducted by Partners’ MHSU UM staff.  Registration is limited.  Participants will receive the zoom platform link and handouts by email one day prior to class. This training does not offer NBCC CEs.

 CALOCUS

Oct. 21, 2021, 8:30 a.m.-12:30 p.m. (Register)

Providers are required to use the CALOCUS clinical tool to evaluate and determine the level of psychiatric and addiction services care needed for individuals ages 6-18. This training is conducted by Partners’ MHSU UM staff. Registration is limited. Participants will receive the zoom platform link and handouts by email one day prior to class. This training does not offer NBCC CEs.

Cultural Competency: CLAS Standards Training

Nov. 9, 2021, 9-11 a.m. (Register)

The Office of Minority Health has established Culturally and Linguistically Appropriate Services (CLAS) standards to address health equity and improve outcomes. This training will not only review the standards but also review the wealth of tools and training materials available free of charge to provider. This training does not offer NBCC CEs.

Additional Training and Announcements

ASAM Training:  The NCDHHS JCB #J399 published on August 16,2021, clarifies four sources providers can use to meet the proposed training requirements in the ASAM criteria.  These four sources will meet the training requirements included in CCP 8C Outpatient Behavioral health Services Provided by Direct Enrolled Providers and 8A-5 Diagnostic Assessment. http://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins

Request for Information—Multidisciplinary Evaluations (RFI #0721-001):

Partners Health Management (Partners) initiated this Request for Information (RFI) to solicit responses from appropriately qualified organizations to conduct Multidisciplinary Evaluations (MDE) for individuals. This RFI is being issued to specifically identify organizations interested in and qualified to become enrolled as approved network providers through Partners credentialing process. Qualified in-network providers are strongly encouraged to apply. Depending on the volume of responses Partners will either select a number of providers to enroll or will issue a full Request for Proposals.

The RFI, located at https://providers.partnersbhm.org/request-for-services/, offers an overview of Partners, requirements and links for additional resources. Please review the RFI and if you are interested in being considered for provision of these services with Partners, complete the Response to RFI (found by clicking on the hyperlink in the RFI.)

To be considered for provision of this service, all responses to the RFI need to be submitted by Friday, August 20, 2021 at 5 pm. Issuance of an RFI or RFP does not guarantee a financial award, nor does it indicate a commitment on the part of the issuer to pursue further contractual relationship.

Any Frequently Asked Questions (FAQs) will be posted to the Partners website with the RFI approximately 15 days after the release of the RFI. Please contact Lisa Jordan at ljordan@partnersbhm.org with any questions.

Quality Performance Improvement Projects due Aug. 31, 2021: All contracted providers are expected to submit three Quality Improvement Projects (QIPs), or PIPs (Performance Improvement Projects) by Aug. 31, 2021. If your organization has not created a ShareFile folder necessary for the upload project, please email Tamikka Woods at twoods@partnersbhm.org to start the process of creating your provider ShareFile folder. In your email, please include the name of the best person to contact, the contact number and email address.

Providers who set up a ShareFile folder last year should continue to use that folder this year and every year moving forward until further notice.

Providers are reminded that it is a requirement that contractors of Partners’ (both Medicaid and State-funded) participate in Quality Improvement (QIP) or Performance Improvement Projects (PIP). Currently, we are not requiring licensed independent practitioners to participate in this process.

Directions on how to upload your PIP/QIPs via ShareFIle:

  • If you, the provider, do not have a ShareFile folder established for upload of PIP/QIPs, send the name, phone number and email address of your contact/representative (preferably staff that is responsible for QI activity) to twoods@partnersbhm.org. You will receive an email from ShareFile. Once you receive this email, follow the instructions for creating a password. Send updated information as appropriate for staff changes of this activity to avoid deadline not being met.
  • Upload three Quality Improvement Projects by August 31, 2021. There are no specific topics required at this point.
  • Every year, by the last business day of August [the next deadline will be August 31, 2022], until further notice, the expectation is for providers to submit three Quality Improvement Projects in this manner.

If your ShareFile folder does exist but needs to be associated with a different staff member within your organization:

  • Send an email with the provider’s name and the new staff information (email and contact number) to twoods@partnersbhm.org.
  • The new staff member will be sent an email from ShareFile with instructions on how to set up a password to allow the upload of the QI projects.

Some providers may have active projects in the ShareFile folder. If the target dates have not passed, these can count toward the three projects. If you have any questions, please contact Tamikka Woods.