Guidance Regarding Rate Increases and Claims Re-Adjudication

Partners has increased several rates since September 2021. It is our goal to ensure that rates are loaded properly, and providers are paid the correct rate.

Claims are identified and re-adjudicated for processing if they have been previously submitted for dates of service included in the update. Due to this process, providers may experience changes in their remittance advice as part of this process.  Please note that the re-adjudication may not always result in an increase for clinician-based services since we do not see the license level in the claim detail.

If you have questions regarding rates, please contact your assigned provider account specialist or email pas@partnersbhm.org

If you have questions regarding billing and claims, please email claimsdepartment@partnersbhm.org or call 704-842-6486.

Service Authorization Requests for Medicaid (b)(3) Individual Support

Effective March 31, 2022, the following changes will be made to the benefit limits for (b)(3) Individual Support. This applies to new or initial requests for Individual Supports.

Service Description Benefit Limit Level of Care Source Documentation Required for Authorization
Individual Support: MH Adult 18+:

 

T1019U4 (DJ) (EP)

T1019UT (TS) – (b)(3) Individual Support Community Only

Initial: Pass-through of 344 units per 30 days, only once per treatment episode, once per fiscal year, up to 180 days.

 

1st Concurrent and Beyond: Up to 2,064 units per 180 days.

 

 

LOCUS: 2 (b)(3) Notification SAR is Required for Pass-through on Initial Service Authorization Request (SAR)

 

1st Concurrent and Beyond: Updated Tx Plan or PCP needed with each concurrent with Signature Page, Service Order, service and frequency. Service Order may be signed by a QP.

 

 

For existing members receiving (b)(3) Individual Supports without an authorization in Alpha, provider will need to submit a Service Authorization Request (SAR) for medical necessity review on or before March 31, 2022. This SAR will need to include required clinical documentation indicated above.

The COVID-19 flexibility codes below for (b)(3) Individual Support do not require prior approval. Please maintain all clinical documentation as required by the service definition, with the provider.

  • T1019 U4 CR
  • T1019 U4 GT CR

For information on Medicaid (b)(3) Individual Support benefit limits, please refer to the Medicaid (b)(3) Individual Support Service Definition.

If you have additional questions regarding SAR submissions, please contact the MH/SU Utilization Management Workgroup by calling 704-842-6436.

Claims Information

Providers are reminded to use the email claimsdepartment@partnersbhm.org for all email inquiries so that 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 claimsdepartment@partnersbhm.org to schedule a time for training.

 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.

Dec. 2021: Medicaid—Number of Days to Process and Pay All Claims
Received Date to Paid Date: 9.6

 

Top Five Medicaid Claim Denials for Dec. 2021

Claim Denial

Provider Recommended Action Steps

Service is not authorized. Verify Service Authorization for consumer/member. Contact Utilization Management.
Duplicate claim. The claim has previously been submitted and adjudicated. Do not refile.
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.
Billing Taxonomy Submitted is not associated with the billing NPI Rebill claims with the correct taxonomy/NPI information.

 State News and Updates

NCDHHS Outlines Priorities to Strengthen the State’s System of Community-Based Services and Supports for People with Disabilities in the 2022-23 Olmstead Plan: The North Carolina Department of Health and Human Services published its Olmstead Plan, designed to assist people with disabilities who receive or are eligible for publicly-funded services to reside in and experience the full benefit of being part of day-to-day life in communities alongside those without disabilities. Developed with stakeholders from across the state, the plan’s goal is to divert people from entering institutions and to support those wishing to leave.

The Olmstead Plan serves as a blueprint for how NCDHHS, the Office of the Governor and other governmental agencies and their partners, with support from the North Carolina General Assembly, make decisions about services to fund and support the health and well-being of North Carolinians with disabilities. The plan outlines an approach to the array of services and supports vital to community living. Access to housing, employment, home and community-based services and other supports are addressed in the plan.

NC Medicaid Direct Care Worker HCBS and ICF/IDD One-time Bonus; Wage Increase: The recently adopted North Carolina annual appropriations bill includes funds to give a one-time bonus to eligible direct care workers (DCWs) and support staff who provide services to Medicaid and NC Health Choice beneficiaries. The State budget also includes a provision to implement a home and community-based services (HCBS) and intermediate care facility/individuals with intellectual disabilities (ICF/IID) DCW wage increase for eligible employees who provide services to Medicaid and NC Health Choice beneficiaries.

Details about the three categories of eligibility criteria can be found in the following NC Medicaid provider bulletins, posted Jan. 14, 2022:

  • COVID-19 BULLETIN #212 One-Time Bonus: DCWs and support staff in waiver programs, personal care services, home health and others may be eligible for a one-time bonus – DCWs and support staff in eligible waiver programs, personal care services, home health and others may be eligible for a one-time bonus
  • COVID-19 BULLETIN #213 ICF-IID Wage Increase: DCWs in Intermediate Care Facilities for Individuals with Intellectual Disabilities may be eligible for a wage increase
  • COVID-19 BULLETIN #214 HCBS Wage Increase: DCWs providing home- and community-based service may be eligible for a wage increase

NC Medicaid will hold webinars from Jan. 19-25, 2022, to provide an overview of the wage increase and bonus program. Webinar information is located in the provider bulletins listed above.

January Fireside Chat: Please join NC Medicaid Chief Medical Officer (CMO) Dr. Shannon Dowler along with the NC Medicaid Managed Care Plan CMOs, for the January Fireside Chat on Thursday, Jan. 20, 2022 from 5:30 p.m. – 6:30 p.m. Register for the webinar at https://www.ncahec.net/practice-support/medicaid-managed-care-2/.

This webinar will cover important COVID-19 surge updates related to Medicaid flexibilities and will provide updates on vaccination data and incentive programs offered by the PHPs. We will explain the new enhanced COVID-19 vaccination administration rate and will highlight NC legislative updates that impact NC Medicaid. Finally, we will look ahead on what is upcoming in 2022 in the areas of behavioral health, managed care, social drivers of health and clinical policy.

Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars, as well as recordings, slides and transcripts from previous webinars.

NCDHHS Resources:

Provider Meetings and Collaboratives

Autism Services Collaborative

January 27, 2022, 10-11:30 a.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 are:

  • 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.

Partners’ Provider Council

Fourth Friday of the month. Providers meet beginning at 9:30 a.m.; Partners staff joins at 10:30 a.m. (Register)

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. This month’s meeting will be held on Friday, Jan. 28, 2022.

Partners Diversity and Inclusion Collaborative

February 10, 2022, 2-4 p.m. (Contact training@partnersbhm.org for details)

Partners is excited to announce the initial meeting of a quarterly provider led Diversity and Inclusion Collaborative. All providers are welcome but a one-year commitment to the collaborative is requested.

Primary Objectives

  • Promoting training and events to bring awareness to diversity, equity and inclusion within the LME/MCO and provider agencies
  • Engage LME/MCOs and providers in diversity, equity and inclusion conversations
  • Reviewing and developing policies and procedures that will promote diversity, equity and inclusion within the LME/MCOs and provider organizations
  • Develop and promote strategies and best practices within the realms of racial, social, sexual and gender diversity
  • Review and removal of systemic barriers to minority providers

Areas of Diversity and Inclusion include:

  • Race
  • Ethnicity
  • Age
  • National origin
  • Sexual orientation
  • Cultural identity
  • Assigned sex
  • Gender identity

All meetings are being held virtually. Please contact training@partnersbhm.org to be included in this kickoff meeting.

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.

Partners Licensed Independent Practitioner (LIP) Collaborative

Feb. 16, 2022, Noon-1 p.m. (Register)

The Licensed Independent Practitioner (LIP) Collaborative was developed to improve communication between Partners and LIPs in our network. Meetings are held quarterly via conference call or webinar.

Partners LGBTQ Collaborative

Third Thursday of each month, 2-3 p.m. (Register)

Partners sponsors a monthly provider-led LGBTQ Collaborative. Topics covered include brainstorming provider initiatives, case consultation addressing LGBTQ topics of interest and support, celebrations of accomplishments, resources sharing and training needs. Please join us for this interactive session of learning and community. All meetings are held virtually.

Quarterly Provider Forum

Partners hosts a quarterly provider for to share updates and vital information with providers. Join us for on March 9, 2022 from 1-3 p.m. (Register here)

Provider Training

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/

TruCare Demo Part 1: Care Management Functions

February 1, 2022, 3-4 p.m. (Register)

Join Partners Training Academy in a demonstration of the care management functions of TruCare for potential TCM providers:

  • Case assignment
  • Assessments
  • Care Plans and Care Notes
  • Task assignment/management
  • Risk stratification

Motivational Interviewing

March 7 and 8, 2022, 9 a.m.-5 p.m. (Register)

Join Partners Training Academy for this two-day, interactive virtual live training that will cover the fundamentals of Motivational Interviewing (MI). 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 for Monday and Tuesday (3/7 and 3/8), You must attend both training to receive cred/it. 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 training@partnersbhm.org

Trainer: Tami Grossens

Twelve Step Facilitation Training

February 15, 2022, 9 a.m.-12:15 p.m. (Register)

Join Partners Training Academy for Twelve Step Facilitation Training. Learn more about what it really means to use this evidence-based practice to maximize opportunities for long term recovery, connection, and deeper life satisfaction.

Training will take place over two days, February 15 and 17, 2022 9:00 a.m. – 12:15 p.m.
Participants will have to be present with audio and visual capabilities for all sessions to receive credit. No partial credit will be given.

NCSAPPB approved for up to 6 hours
NBCC Approved 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.
If you need accommodations, please email training@ partnersbhm.org.

Trainer: Eric Ottinger

CBT Learning Community

Two sessions:

  • February 16, 2022, 2-3:30 p.m. (Register)
  • March 16, 2022, 2-3:30 p.m. (Register)

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.

Surviving and Thriving as a Helping Professional

February 22, 2022, 1-4 p.m. (Register)

Join Partners Training Academy for an interactive training to examine the challenges of Compassion Fatigue, Compassion Satisfaction, and Burnout. The COVID Pandemic and Opioid Crisis have created an unprecedented level of stress on society, and in particular on those serving on the frontlines of care in mental health, developmental disabilities and substance use disorder services.

Research-based and practical, this three-hour interactive training is customized for the unique stressors of this group of professionals. Participants will explore protective and risk factors that inherently exist in working on the front lines of with human suffering, examine healthy and unhealthy workplace dynamics, and collaborate as clinical professionals on unique ways to cultivate compassion satisfaction and approach these challenges. Those who attend will assess their individual measures in these areas and emerge with in-depth knowledge and better understanding of ways to expand their own resilience as helping professionals.

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.
If you need accommodations to attend this training email training@partnersbhm.org.
Trainer: Joanna Linn

Cognitive Behavioral Therapy (CBT) Foundations

March 1 and March 3, 2022, 9 a.m.-12:15 p.m. (Register)

Join Partners training Academy for Cognitive Behavioral Therapy (CBT) training. 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 two, three-hour sessions on March 1 and March 3. 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.
If you need accommodation to attend this training email training@partnersbhm.org
Trainer: Eric Ottinger

Addressing the Workforce Crisis Session 1

Two opportunities:

Join Partners Training Academy as we explore ways to address the DSP workforce crisis. This session will focus on evidence-based training programs that promote best practices; adult learning best practices; partnerships with high schools and local colleges for early identification and recruitment; and career ladders and wage incentive programs.

This session does not offer continuing education credits.

If you need accommodation to attend this training email training@partnersbhm.org

Co-Facilitators: Matthew Potter and Matthew James

Addressing the DSP Workforce Crisis Session 2

Two opportunities:

  • March 14, 2022, 10 a.m.-12 p.m. (Register)
  • March 18, 2022, 1 p.m.-3 p.m. (Register)

Join Partners Training Academy as we explore ways to address the DSP workforce crisis. This session will focus on why are we doing this; the rights and dignity of People with Disabilities/Social Justice framing; Creating a culture of Value and Power Sharing; Effective Supervision- Clinical Coaching; Continuous quality improvement and data-based decision-making for workforce; and Regional Council funding.

This session does not offer continuing education credits.

If you need accommodation to attend this training email training@partnersbhm.org

Co-Facilitators: Matthew Potter and Matthew James

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 Tutorials

  • 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

Community Training

All Trainings are virtual via Zoom and last two hours unless otherwise specified. For more information contact: Jeanne Patterson, jpatterson@partnersbhm.org, or Amber Matthews, amatthews@partnersbhm.org

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.

Risk & Resilience Buffering Toxic Stress: Modules 1-3

February 1, 2022, 2 p.m. (Register)

This training provides information about how early childhood stress and trauma can result in negative outcomes in areas of learning, behavior and health throughout the lifespan. The definition of early childhood mental health as promoting healthy social emotional development through nurturing young minds from birth throughout early childhood is the core principle of this training

Risk & Resilience Buffering Toxic Stress: Module 4-Limbic Calming and Module 5-Cortical Coping

February 2, 2022 2 p.m. (Register)

This is a follow-up to Modules 1-3. Module 4 teaches how to help very children calm their limbic systems. In Module 5 we will learn about healing the cortical brain to develop active coping skills such as impulse control and problem solving.

Risk & Resilience Buffering Toxic Stress Module 6: Building Adult Resilience

February 3, 2022, 10 a.m. (Register)

We have focused on young children and how we can support their development. This final module shifts to the importance of well-being in adults and how we can continue to build our resilience. Modules stand alone and there are no prerequisites to attend any of the modules.

Introduction to Trauma and Resilience

February 9, 2022, 10 a.m. (Register)

Most of us have experienced trauma at some time. This can have a lasting effect on our learning, behavior, and health. Learn about trauma and how to address the effects as well as ow to develop resilience.

QPR (Question Persuade Refer) Suicide Prevention

February 11, 2022, 10 a.m. (Register)

Many have experienced recent losses. The risk of suicide is still high. This training teaches the skills to intervene in a suicide crisis.
**the maximum number of people allowed to participate in a virtual QPR training at one time is 30; registration is on a first come first serve basis.

Community Resilience Model® (CRM)

February 16, 2022, 2 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.

Darkness to Light

February 18, 2022, 10 a.m. (Register)

This training provides education about child sexual abuse and the steps you can take to prevent and report child sexual abuse. This training is offered two times in April. You may register for either one. Seats are limited. Please register early.

Human Trafficking: Keeping Our Children Safe

February 21, 2022, 10 a.m. (Register)

Human Trafficking is a global problem, even in the United States. Children may be spending more time online than usual. Learn about trafficking around the world and some ideas about how to keep our children safe.

Domestic Violence: How to Help

February 22, 2022, 10 a.m. (Register)

Many of us are still home more than usual and the risk for domestic violence is high. Learn how to spot the signs of domestic violence and how to help.

Trauma Informed Care

February 28, 2022, 2 p.m. (Register)

Let’s look at how our behavior affects others with trauma history. What are some simple changes we can make using what we know about trauma?

An Introduction to Child and Family Teams: A Cross-System Training from The Family’s Perspective (Part 1)

April 6 and 7, 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

Tools for Your Trade: Brain Injury and Behavioral Health
February 2, 2022, Noon (Register at https://www.nashia.org/trainings/feb2022lemsky)
Learn about two new customized tools to guide behavioral health and community providers in supporting better outcomes for individuals with brain injury and behavioral health needs. Dr. Carolyn Lemsky, Clinical Director for the Community Head Injury Services of Toronto (CHIRS), will conduct an overview of the tools and how to utilize them in your program:

  • Traumatic Brain Injury and Substance Use Disorders: Making the Connections
  • Substance Use and Brain Injury Client Workbook: Second Edition

Affordable Connectivity Program Helps People Pay for Internet Services and Connected Devices: The Affordable Connectivity Program (ACP) is a Federal Communications Commission (FCC) program that replaces the Emergency Broadband Benefit Program (EBB Program) to help low-income households pay for internet service and connected devices.

Eligible households may receive:

  • Up to a $30/month discount on your internet service
  • Up to a $75/month discount if your household is on qualifying Tribal lands
  • A one-time discount of up to $100 for a laptop, tablet, or desktop computer (with a co-payment of more than $10 but less than $50)

Only one monthly service discount and one device discount is allowed per household. To receive the connected device discount, consumers need to enroll in the ACP with a participating provider that offers connected devices (Note: Not all internet companies offer device discounts.) The internet company will provide the discount to the consumer.

Useful links:

Partners Community Collaboratives: Partners sponsors a 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