In This Bulletin:
- NCDHHS Announces Updated Launch for Tailored Plans
- Partners Quarterly Provider Webinar and Provider Council
- County Realignment Updates
- Service Authorization Requests for Peer Support Services
- NC Innovations Appendix K Flexibilities
- Claims Information
- State News and Updates
- Provider Training
- Community Training
- Additional Events and Training
NCDHHS Announces Updated Launch for Tailored Plans
On Tuesday, Nov. 15, 2021, The North Carolina Department of Health and Human Services announced that Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans will launch Dec. 1, 2022, instead of July 1, 2022. Read the press release.
Partners Quarterly Provider Webinar and Provider Council
Partners hosts a Quarterly Provider Webinar to communicate important information and detailed updates to our providers about a variety of topics. The next webinar will be held on Dec. 8, 2021, from 1-3 p.m. All providers in the Partners’ provider network are invited to attend. Register now.
The Partners’ Provider Council is a professional representative and advocates for all service providers in the Partners’ service 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 Nov. 19, 2021, at 9:30 a.m. Register now. The Provider Council will not meet in December.
County Realignment Updates
Providers are reminded to frequently visit our County Realignment resources:
- Partners Provider Knowledge Base: https://providers.partnersbhm.org
- Cardinal/Partners Service Code Crosswalk: https://providers.partnersbhm.org/cardinal-partners-service-code-crosswalk/
- Utilization Management Information about County Realignment: https://providers.partnersbhm.org/um-and-county-realignment/
- Transitioning to AlphaMCS/Alpha CM: https://providers.partnersbhm.org/transitioning-to-alphamcs/
- NC-TOPPS Member Transfers: https://providers.partnersbhm.org/provider-alert-county-realignment-new-clozapine-rems-training/
- Provider Frequently Asked Questions: https://www.partnersbhm.org/county-realignment/providerfaq/
- Partners’ Open Network Approach: https://www.partnersbhm.org/county-realignment/#openapproach
- Partners Communication Bulletin Archive: https://providers.partnersbhm.org/provider-communication-bulletin/
- Partners Provider Alert Archive: https://providers.partnersbhm.org/provider-alert-archive/
- Contact information: https://providers.partnersbhm.org/provider-network-help-desk-contacts/
Service Authorization Requests for Peer Support Services
Effective Nov. 10, 2021, prior authorization will no longer be required for Medicaid or State-funded Peer Support Services to include the base code or any of the following modifiers:
|Medicaid Peer Support Services||State Peer Support Services|
|H0038 Peer Supports Individual||H0038 Peer Supports Individual|
|H0038 (HK) Peer Support Individual Timely Follow-up||H0038 (TY) Peer Support Services Timely Follow-up|
|H0038 (HQ) Peer Supports Group||H0038 (HQ) Peer Supports Group|
|H0038 (DJ) Peer Support Individual DOJ|
|H0038 (HQ)(DJ) Peer Support Group DOJ|
|H0038 (EN) Peer Support Encounter|
COVID-19 flexibility codes for Peer Support Services do not require prior authorization.
The following clinical documentation, as stated in Clinical Coverage Policy 8G, is required for both Medicaid and State-funded Peer Support Services:
- A Service Order is required and is due on or before the first date of service. The Service Order is valid for one year.
- A comprehensive clinical assessment (CCA) that demonstrates medical necessity must be completed by a licensed clinician prior to the provision of this service.
- A Person-Centered Plan (PCP) is required and must be completed within 30 days from the start of service. Updated PCP must include progress towards goals along with the signature page.
For information on Peer Support Services benefit limits, please refer to the State and Medicaid Service Definitions. If you have additional questions regarding SAR submissions, please contact the MHSU Utilization Management Workgroup at 704-842-6436.
NC Innovations Appendix K Flexibilities
In March of 2020, NC Medicaid received approval from CMS to allow specific NC Innovations flexibilities that started in April 2020. The original end date was March 12, 2021. Since that time, CMS permitted the state to enter requests to extend the flexibilities and approved NC Medicaid’s request to continue Appendix K flexibilities up to six months past the end of the Public Health Emergency.
As announced on https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVDI-15Oct21.aspx, the COVID-19 public health emergency was extended and effective on Oct. 18, 2021, which means it is scheduled to end on Jan. 15, 2022. Public Health Emergencies are only extended 90 days at a time. NC Innovations Appendix K Flexibilities will continue up to six months past Jan 15, 2022, ending on July 15, 2022, unless otherwise determined by NC Medicaid. NC Medicaid has the authority to end the Appendix K Flexibilities prior to the end of the six-month period if deemed appropriate.
Suspended Medicaid Deductibles / Spend Downs:
- The suspension of Medicaid spend downs will end when the Public Health Emergency ends and is not linked to the Innovations Waiver Appendix K Flexibilities.
- If the Public Health Emergency ends on Jan. 15, 2022, the Medicaid spend-down will resume on Feb. 1, 2022. (The month following the end of the public health emergency).
Reminder: Providers and Employers of Record should complete the Appendix K form (available at https://providers.partnersbhm.org/covid-19-provider-forms/ ) with a beginning date and projected end date and description of the Appendix K Flexibility being used and the justification for use. Providers and Employers of Record should email the completed Appendix K form to Innovationsexceptions@partnersbhm.org and copy the Care Manager and Acumen (if the member is self-directing in the EOR model) on the email.
Please direct questions regarding Appendix K Flexibilities to InnovationsExceptions@partnersbhm.org.
Individual Supports-Community Only/Licensed Facilities
Partners asks providers to use the Individual Supports-Community Only service code (T1019 U4 TS) for Individual Supports services provided in licensed facilities, based on guidance from the state and pending formal communication regarding Individual Supports services provided in licensed facilities. This service should be billed directly to Partners and does not require electronic visit verification through HHaX.
Providers should submit the Provider Change Form, located at https://providers.partnersbhm.org/provider-enrollment-credentialing/ to add this service to sites where Individual Supports is being offered in licensed facilities.
Partners will make the service effective Sept. 1, 2021, for these services impacted by electronic visit verification denials. Claims previously submitted/denied as T1019 U4 will need to be resubmitted as T1019 U4 TS.
- For questions about adding this service to sites, please contact your provider account specialist or email firstname.lastname@example.org.
- If you have questions regarding claims, please email email@example.com or call 704-842-6486.
Providers are reminded to use the email firstname.lastname@example.org for all email inquiries so that they are handled in the most efficient manner. Please do not send email directly to individual employees.
Explanation of Benefits requests for Coordination of Benefits Claims
As 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.
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.
|October 2021: Medicaid—Number of Days to Process and Pay All Claims|
|Received Date to Paid Date:||8.4|
Top Five Medicaid Claim Denials for October 2021
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 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.|
|Claim received after billing period.||Write off charges as non-billable. Do not rebill.|
|Referenced claims have already been resubmitted. Multiple resubmissions not allowed.||Check the Reference Claim # to verify it references the original claim. The duplicate resubmission will contain the same reference.|
State News and Updates
- NC Medicaid Managed Care Update: Providers are reminded to visit https://medicaid.ncdhhs.gov/providers/provider-playbook-medicaid-managed-care frequently for the latest updates.
- 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 are available at https://medicaid.ncdhhs.gov/providers/medicaid-bulletin/medicaid-bulletin-digests. Providers are encouraged to frequently 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.
Provider Open House
Dec. 4, 2021, 9 a.m.-11 a.m. (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.
Dec. 6 and Dec. 7, 2021, 8:30 a.m.-5:00 p.m. (Register)
Join Partners Training Academy for this two-day, interactive virtual live training that will cover the fundamentals of Motivational Interviewing. This training will be done by a MINT trainer and will meet NC service definition training requirements. 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 on Monday, Dec. 6 and Tuesday, Dec. 7. You must attend both days to receive credit. No partial credits will be given.
Approved for 13 NBCC CEs. 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.
If you have any accessibility or accommodation needs, please email email@example.com.
CST Service Definition Webinar
Dec. 9, 2021, 8:30 a.m.-11:45 a.m. (Register)
This webinar meets the requirement for three hours of CST Service Definition Training. Registrants will view a previously recorded training that includes two 10-minute breaks. To receive a training certificate, registrants will need to view the full webinar and pass a ten-question quiz with a score of 80% or greater. This session does not offer NBCC CEs
Children With Complex Needs/Dual Diagnosis Forum
Second Friday of the month, 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 their communities to join us for this forum.
Three opportunities available:
- 13, 2021, 12:30-1 p.m. (Register)
- 17, 2021, 12:30-1 p.m. (Register)
- 21, 2021, 12:30-1 p.m. (Register)
Many providers abruptly dove into offering telehealth services without the benefit of training and preparation. This 30-minute prerecorded webinar reviews the benefits of telehealth service delivery, considerations for sessions, practice applications, as well as staff training and competency. NBCC credits will not be offered for this training.
Cognitive Behavioral Therapy (CBT) Foundations Training
Dec. 14 and Dec. 16, 2021, 9:00 a.m.-12:15 p.m. (Register)
Trainer: Eric Ottinger
Cognitive Behavioral Therapy (CBT) is an evidence-based practice that focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation and 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 12/14 and 12/16. You must attend both training courses to receive credit. No partial credits will be given.
NCSAPPB and NBCC approval for up to six 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.
If you have any accessibility or accommodation needs, please email firstname.lastname@example.org.
CBT Learning Community
Join like-minded providers in a learning community to explore skills, concepts, case studies, and expand your techniques. This learning community will help you to learn practical ways to use evidence-based practices in your day-to-day work with members. This session does not offer NBCC CEs.
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/
On-Demand: Abuse, Neglect and Exploitation Training: https://www.partnerstraining.org/training-library/
Trainer: Chandra Henson, Catawba County Social Services.
The Partners Training Academy Learning Library offers on-demand material (less than 30 minutes) for providers. Learn about APS processes, provider responsibilities, as well as signs and symptoms of potential mistreatment, exploitation and abuse. No National Board of Certified Counselors (NBCC) continuing education credits will be offered.
On-Demand Housing Training: https://www.partnerstraining.org/training-library/
The Partners Training Academy Learning Library offers brief on-demand materials for providers who work with members seeking housing. These are designed for those new to the material. Ideal for new staff orientation and training.
- Housing Resources Overview
- Housing First Model
- Homelessness and Housing for People with Behavioral Health Challenges
Technical Assistance Collaborative (TAC) materials
- Section 8 Made Simple
- Vouchers Database by County in NC
Partners Community Café
Fourth Wednesday of the month, 10-11 a.m. (Register)
Join Partners for our monthly Community Café, where we focus on relevant issues, concerns and ideas to improve the lives of those we serve. Join us on Nov. 24, 2021, at 10 a.m., where we will discuss veterans’ resources, including housing, veterans court and more.
Community Resilience Model® Training
Nov. 23, 2021, 10 a.m.-noon (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)
Feb. 23 and 24, 2022, 8:30 a.m.-4:30 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
Share your feedback – Union County Community Health Improvement Plan (CHIP): The Healthy Union Advisory Committee-Mental Health Subcommittee is seeking input from leaders who work in the area of Mental health in Union County and would appreciate your feedback on this brief questionnaire. Your responses will inform the Union County Community Health Improvement Plan (CHIP). The group’s work stems from the tri-annual Community Health Assessment (CHA) and its main goal is to listen to what is happening in our community, identify available resources to improve access, recognize gaps in services, and bring back insights and suggestions to place in the Union County CHIP. If you have any questions or concerns, please reach out to Catherine Wright (email@example.com) or Stephanie Starr (Stephanie.Starr@unioncountync.gov). To complete the questionnaire, visit https://www.surveymonkey.com/r/Q57W6H3.
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:
UNC Institute for Best Practices https://www.institutebestpractices.org/
Offers training and support for assertive community treatment (ACT), individual placement and support (IPS) and other best practices. (NC providers only). Virtual trainings are offered through the end of 2021, including Disclosure training, EPM training, Follow Along Supports, IPS 101 training, Job Development training and Career Profile training. The Institute also hosts NC CST Support meetings, NC ACT Coalition Meetings and EPM meetings. See the training calendar for details and registration: https://www.institutebestpractices.org/my-calendar/
Permanent Supportive Housing PSH/CST training
Four-day virtual training: December 1, 2, 8 and, 9 from 9 a.m. to 1:30 p.m. (Register)
Due to a collaborative training arrangement, providers in the Partners network can attend the 15 hr. PSH/CST hosted by Vaya.
This online training will support CST and ACTT providers by improving their understanding and practice of the Permanent Supportive Housing model. Full attendance is required for all four days to receive credit. A link will be sent out to participants one to two business days before the event.
Permanent Supportive Housing PSH/CST training
Three-day virtual training: December 7, 8 and 9, 2021 from 8 a.m. to 1:30 p.m.
Due to a collaborative training agreement, Partners providers can attend the 15 hr. PSH/CST hosted by Alliance. Registration deadline is December 2, 2021.
- Registration for day one (Dec. 7): https://alliancehealthplan.zoom.us/meeting/register/tJMld-CurDgqEt1OKowwDf22WSCg4WYdDgmB
- Registration for day two (Dec. 8): https://alliancehealthplan.zoom.us/meeting/register/tJUlf-msrz8jH9PSpGUTXqulI7revzqhtyT6
- Registration for day three (Dec. 9): https://alliancehealthplan.zoom.us/meeting/register/tJ0kcO-grDovHdSjp_a8MQvxagDAXFFLLsc9
This online training will support CST and ACTT providers. Priority is given to Alliance’s in-network CST team members who need training to be in compliance with the clinical coverage policy. Registrants are required to log on by 7:45 a.m. each day.
NCDHHS JCB #J399 identifies four American Society of Addiction Medicine (ASAM) training resources that can now be utilized to meet the proposed training requirements regarding ASAM criteria for the CSM 1115(a) Substance Use Disorder (SUD) Demonstration Waiver. These four resources will offer ASAM training to meet the training requirements included in Clinical Coverage Policies 8C Outpatient Behavioral Health Services Provided by Direct Enrolled Providers (outlining the requirements of the Comprehensive Clinical Assessment) and 8A-5 Diagnostic Assessment.
- UNC Behavioral Health Springboard: https://bhs.unc.edu/asam/dashboard
- Train for Change: https://www.trainnet/open-events
- The Change Company: https://www.changecompanies.net/etraining/
- ASAM Criteria Online foundations Course (e-Learning Modules): https://elearning.asam.org/the-asm-criteria-educational-offerings
Providers who complete CCAs and DAs who are not previously trained in ASAM are encouraged to gain training prior to the Clinical Coverage Policy final approval.