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County Realignment Updates

Utilization Management Updates for providers serving members in Cabarrus, Stanly, and Union counties: Partners has assumed the Utilization Management functions for behavioral health and intellectual and developmental disabilities services delivered in Cabarrus, Union, and Stanly counties. Partners has received information about all authorizations that have been issued up to August 31, 2021. Partners Utilization Management is in the process of entering authorizations to eliminate any undue administrative burden for providers. All of the authorizations should be entered by Sept. 30, 2021. If you discover, after Sept. 30, 2021, that an authorization scheduled to be effective Sept. 1, 2021 is missing, please send an email to UMquestions@partnersbhm.org with the authorization provided by Cardinal Innovations. To ensure continuity of care, please continue to provide services at the same frequency as previously authorized during this transition.

There are services that may not have required an authorization with Cardinal Innovations but require an authorization with Partners. These services will remain unmanaged through June 30, 2022.  In order for a provider to bill for services that Cardinal Innovations did not manage, the provider will need to report these unmanaged services to Partners on the Unmanaged Services Spreadsheet as soon as possible

These services include:

  • (b)(3) 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

Please complete the Unmanaged Services Spreadsheet and return (via encrypted email) to Jen Gennerman at jgennerman@partnersbhm.org. Partners encourages providers to continue to deliver services at the same frequency as members received prior to the transition.

If you have questions, please contact the UM Department at UMquestions@partnersbhm.org.

Service Code Crosswalk: Partners Utilization Management (UM) developed a Cardinal/Partners Service Code Crosswalk to assist providers with the seamless transition of services to members in Cabarrus, Stanley and Union counties. 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 “Welcome to Partners Provider Information Sessions, as well as recordings of previous events, can be found at https://www.partnersbhm.org/county-realignment/#provider-events.

Other County Realignment resources:

Partners Community Collaboratives: Partners sponsors monthly community collaborative in each of the counties in the service region. Community Collaborative groups consist of representatives from local government agencies, community organizations, and service providers, as well as individuals, families and advocates who work together in a specific community to identify and solve problems for children, adolescents, adults, and families struggling with mental health and substance use. Together, group members:

  • Identify gaps in services.
  • Partner with agencies and families.
  • Develop helpful resources.
  • Assist providers and families with issues related to services.
  • Ensure access to quality services.

Currently, all collaboratives are meeting virtually. If you are interested in learning more about this

group or attending, please email Partners Community Engagement.

Select a county below to go to the associated collaborative information:

·        Burke

·        Cabarrus

·        Catawba

·        Cleveland

 

·        Gaston

·        Iredell

·        Lincoln

·        Rutherford

 

·        Stanly

·        Surry

·        Union

·        Yadkin

 

Medicaid Transformation

Help with Members Moving between Standard Plans and NC Medicaid Direct:

Partners’ Transition of Care Coordinator and Care Management team meet with representatives from the Standard plans daily. We and can help facilitate communications for members who are requesting to move from one plan to another. Providers and members can email Transition of Care at toc_partners@partnersbhm.org or call 704-842-6334.

Members can also contact the NC Medicaid Ombudsman at 1-877-201-3750 to ask questions about their health plan.
Provider Ombudsman
The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.  Additionally, the Ombudsman will assist providers with Health Information Exchange (HIE) inquires related to NC HealthConnex connectivity compliance and the HIE Hardship Extension process.

Provider Ombudsman inquiries, concerns or complaints can be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov, or providers may utilize the Provider Ombudsman line at 866-304-7062. The Provider Ombudsman contact information will also be published in each PHP provider manual.

State News and Updates

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.

Key Milestone Dates for NC Medicaid Managed Care

July 1, 2021 NC Medicaid Managed Care Launch
Aug. 1, 2021 Last date for most beneficiaries to change their Primary Care Provider (PCP)/Advanced Medical Home (AMH) for any reason
Aug. 30, 2021 Last date by which the health plan will pay claims and authorize services for Medicaid-enrolled out-of-network providers equal to that of in-network providers (or until end of episode of care, whichever is less)
Sept. 29, 2021 Last date by which the health plan must honor existing and active prior authorizations on file with the North Carolina Medicaid or NC Health Choice program (or until the end of the authorization period, whichever occurs first)
Sept. 30, 2021 End of beneficiary choice period

Provider Playbook Updates: The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. New resources added to the fact sheet page includes: Request to Move to NC Medicaid Direct Process – Details the process for beneficiaries currently enrolled in a health plan with NC Medicaid Managed Care who need services only available through NC Medicaid Direct and/or through the LME-MCOs, e.g., intellectual/developmental disability, mental illness, traumatic brain injury or substance use disorder.

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.

Providers Needed: Rapid Response Bed Therapeutic Foster Care (S5145U5) for Children and Youth

Partners Health Management (Partners) is seeking to identify organizations interested in and qualified to become enrolled or are enrolled as approved network providers through Partners credentialing process to offer Rapid Response Bed Therapeutic Foster Care (S5145U5) for eligible children and youth program enrollees.

Our goal is to identify providers able to strengthen and increase the availability of behavioral health services in Partners service area. The organization providing services must have the capability and capacity to provide the needed services as well as demonstrate use of evidenced based practices and a strong system for outcomes measurement.

Partners seeks to increase the network availability of Rapid Response Bed Therapeutic Foster Care. Rapid Response Bed Therapeutic Foster Care (RR) services are provided through 131D Licensed Therapeutic Foster Homes with a North Carolina Licensed Child Placing Agency that provides emergency treatment, structure, stabilization, and supervision to children and youth who are experiencing a behavioral health crisis and who have Medicaid originating from the designated LME/MCO catchment area. This crisis response and stabilization service is treatment focused and intended to support family stability, prevent abuse and neglect, be of short term duration, return children to the home and prevent or minimize the need for out-of-home placements.

Providers of this service must be able to respond to referrals within two hours and notify Partners’ Access to Care department of bed availability daily. This treatment service is designed to maintain family stability, decrease lengths of stay and return the child or youth to the home. Because this service is designed to meet the needs of individuals and families who need crisis stabilization within or near their community and at the same time reducing unnecessary costs of higher levels of care, providers will also be required to demonstrate effective outcomes by reducing use of higher levels of care and returning the majority of children back to their home community within 10 days.

A standard outcomes report will need to be submitted to Partners monthly. Following six months of implementation, Partners’ and the provider(s) will evaluate the effectiveness and cost benefit analysis to determine the need, if any, for modifications or potential discontinuation of the service. This In Lieu Of Medicaid service was approved by the Division of Health Benefits on the condition that the cost of care for these children does not increase as a result of this new service. This budget neutrality is based on reducing use of acute care and restrictive services, like emergency departments, inpatient and Psychosocial Residential Treatment Facility (PRTF). We are seeking providers that have at least two years of provision and expertise in Therapeutic Foster Care services, management of crisis situations and engagement of family members/caregivers in services.

Please refer to the Rapid Response Bed Therapeutic Foster Care Service Description (located at https://providers.partnersbhm.org/request-for-services/ for all treatment elements, core concepts, criteria and requirements that are to be met.

If you would like to be considered for provision of this service and are:

Request for Information—NADD (National Association for the Dually Diagnosed) Certification

Partners is initiating this Request for Information (RFI) to solicit responses from appropriately qualified organizations to participate in a membership and certification process through the National Association for the Dually Diagnosed (NADD). Based on information from www.thenadd.org, NADD is “a membership association for professionals, care providers and families to promote understanding of services for individuals who have developmental disabilities and mental health needs.”

It is important for organizations providing services to individuals with dual diagnosis and complex needs to consider participating in this RFI. The certification process will assist staff to build the skills needed to better serve individuals with multiple diagnoses and needs. Certification is a way to assure payors and members that employees have the skills needed to deliver quality services.

 As Partners continues to support value, innovation and performance across the network, the NADD certification is certainly an opportunity for providers to demonstrate a focus on quality.  This certification may potentially offer opportunities for enhanced compensation in the future. 

 RFI #0921-001 is specifically to identify organizations currently in Partners Provider Network and their employees who are qualified and interested in becoming certified through NADD for Clinical Certification (NADD-CC) and Direct Support Professional Certification (NADD-DSP).

The RFI, available in its entirety at https://providers.partnersbhm.org/request-for-services/, offers an overview of Partners, requirements to submit a RFI response and links for additional resources. To be considered for this RFI, you must submit the required RFI response form by Friday, October 8, 2021, at 5 pm.

 Please go to our website at https://providers.partnersbhm.org/request-for-services/ to review this RFI. 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 within 15 calendar days from the RFI release date.

Claims Information

Reminders

  • Providers should direct all email inquiries to claimsdepartment@partnersbhm.org. so that they are handled in the most efficient manner. Please do not send email directly to individual employees.
  • AlphaMCS Portal Universityis an available resource and guide for navigating AlphaMCS. If you need additional claims training email claimsdepartment@partnersbhm.org to schedule a time for training.
  • 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 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.
August 2021: Medicaid—Number of Days to Process and Pay All Claims
Received Date to Paid Date: 8.9

 

Top Five Medicaid Claim Denials for August 2021
Claim Denial Provider Recommended Action Steps
Duplicate claim. The claim has previously been submitted and adjudicated. Do not refile.
Billing taxonomy submitted is not associated with the billing NPI. Rebill claims with the correct taxonomy NPI information.
Service is not authorized. Verify Service Authorization for consumer/member. Contact Utilization Management.
Claim received after billing period. Write off charges as non-billable. Do not rebill.
No coverage available for Patient/Service/Provider combo.

 

Go to Patient -> Patient Search and search for the patient in question. Check the insurance to ensure the patient has effective insurance covering to date of service submitted on the claim. If this appears to be correct, contact the LME/MCO for further assistance.

Upcoming Events 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, Sept. 24, 2021. Providers will meet beginning at 9:30 a.m.; Partners staff will join at 10:30 a.m. Click here to register.

After registering, you will receive a confirmation email containing information about joining the meeting.

Autism Services Learning Collaborative:

Sept. 29, 2021, 11 a.m.-12:30 p.m. (Register)

The Autism Services Learning Collaborative is an opportunity for providers of Research-Based Behavioral Health Treatment (RB-BHT) and Local Management Entity/Managed Care Organization (LME/MCO) staff to meet periodically as we work to expand the continuum of care available to children diagnosed with Autism Spectrum Disorder.

Goals of this collaborative:

  • To expand the use of evidence-based practices for children diagnosed with autism in order to promote positive outcomes.
  • 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.

Who should attend?

  • RB-BHT providers
  • Clinical directors/supervisors
  • Board Certified Behavior Analysts
  • Quality Management staff

Please send any questions or topics for discussion prior to the meeting via email to Sara Wilson at swilson@partnersbhm.org.

We ask that service providers of RB-BHT send at least one representative from their agency to attend the collaborative. Representation from our RB-BHT service providers will ensure the success of this collaborative. We hope to see you there!

Global Continuous Quality Improvement Committee: Partners hosts a quarterly Global Continuous Quality Improvement Committee. Global CQI is independently composed and led by providers, Consumer and Family Advisory Committee (CFAC) members and stakeholder members with Partners staff serving only in a facilitative role. The provider-led GCQI committee is an open meeting, and all contracted providers are invited to participate with this committee.

Global CQI’s purpose is to promote improvements and processes within provider agencies that lead to greater member satisfaction. Some of the topics discussed are services, provider choice, and best practice models of treatment available in the Partners’ catchment area. Aggregate trends of network performance are also reviewed and addressed in this committee.

If you are interested in learning more about the Global CQI, please contact Tamikka Woods at twoods@partnersbhm.org or call 704-884-2568. The next meeting is Dec. 3, 2021 at 9:30 a.m. and will be held virtually.

Provider Open House

Oct. 7, 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.

Save the Date! Quarterly Provider Webinar: The next Partners Quarterly Provider Webinar will be held on Dec. 8, 2021 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/.

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/

 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/

 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:

  • 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.

 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.

Abuse, Neglect and Exploitation Training

On Demand

Link to training https://www.youtube.com/watch?v=5xgvFRh6XQ0

A new video training is now available in the Partners Training Academy Training Library: Abuse, Neglect & Exploitation Training. Catawba County Department of Social Services (DSS). This is a 27-minute recorded video training. No National Board of Certified Counselors (NBCC) continuing education credits will be offered.

Community Training

Darkness to Light

Sept. 27, 2021 2-4 p.m. (Register)

This training provides education about child sexual abuse and the steps you can take to prevent and report abuse.

Domestic Violence: How to Help

Sept. 28, 2021, 2-4 p.m. (Register)

Many of us are at home more than before due to the COVID-19 pandemic. The risk of violence is high. Learn how to spot the warning signs of domestic violence and how to help.

Community Resilience Model® (CRM) Training

Sept. 30, 2021, 2-4 p.m. (Register)

The Community Resilience Model® teaches participants about the impact of trauma and chronic stress on the nervous system, behavior, and long-term health. Participants learn how to reset the nervous system with easy-to-learn, concrete, coping skills. One of the goals of CRM® is to create trauma-informed and resilient communities.

An Introduction To Child And Family Teams: A Cross-System Training From The Family’s Perspective (Part 1-2)

Oct. 20 and 21, 2021, 9 a.m.-4 p.m. (Register)

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. Sessions must have a minimum of 10 participants. Please do not schedule other appointments during this training. Register soon-this class will fill quickly.

Additional Events and Training

Mental Health/IDD for Direct Support Professionals

Tuesdays starting Nov. 2 to Dec. 7, 2021

The Center for START Services will host a live weekly six-session course that offers Direct Support Professionals (DSPs) the knowledge, skills, and resources needed to provide individuals with intellectual or developmental disabilities and mental health (IDD-MH) service needs with positive, person-centered, strengths and wellness-based supports and services.

Cost: $149

For more information visit https://centerforstartservices.org/MHIDD-DSPs?mc_cid=9da235985b&mc_eid=013aac0698

To register, visit https://learnforlife.unh.edu/portal/events/reg/participantTypeSelection.do?method=load&entityId=152747042.