In This Bulletin:
- Holiday Office Closures
- Check Member Eligibility Prior to Service Delivery
- Rate Increases for LTCS Services
- Alpha+ Provider Scheduler Changes
- State-funded Waitlist/Services Process Information Session
- Claims Information
- State News and Updates
- Training Resource and Collaborative (TRAC)
- Community Training
- Additional Events and Training
Holiday Office Closures
Partners Health Management will be closed Dec. 23, 26 and 27 for the holidays. In addition, Partners will be closed Monday, Jan. 2, 2023, in observance of New Year’s Day. The Access to Care Call Center is available 24/7/365 at 1-888-235-HOPE (4673) to assist individuals looking for resources, services or in a crisis.
Check Member Eligibility Prior to Service Delivery
NC Medicaid moved approximately 50,000 members from Local Management Entities/Managed Care Organizations (LME/MCOs) to Standard Plans on Dec. 1, 2022.
Partners identified a number of members who should remain with the LME/MCOs, and NC Medicaid has now moved those members back to Partners.
Partners is contacting affected providers but encourage providers to check member eligibility in NCTracks prior to service delivery.
For assistance with transitioning members, providers may contact the Partners’ Transition of Care team at:
- Email: toc_partners@partnersbhm.org
- Phone: 704-884-2578
Rate Increases for LTCS Services
The North Carolina General Assembly has allocated funds to encourage Local Management Entities/Managed Care Organizations (LME/MCOs) to improve support for group home residents through the development and implementation of new in-lieu-of services.
The N.C. Department of Health and Human Services (NCDHHS) and Mercer Government Human Services Consulting conducted an analysis to determine rate increases for relevant services in line with the goals of the legislation. Adjustments have been made to LME/MCO capitation rates effective Dec. 1, 2022, and to Tailored Plan and Medicaid Direct BH program capitation rates to be effective when those programs are launched.
The State has identified the following services for rate increases: Individual Support 1915(b)(3) service, future Individual and Transition Support 1915(i) service, and services in-lieu-of Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF ILOS), including Community Living Facilities and Support (CLFS) and Long-Term Community Supports (LTCS).
Partners Health Management, in agreement with the findings, has increased their rates as follows:
|
Procedure Code Description |
Benefit Plan |
Unit |
New Rate |
Increase (31.6%) |
|
| T2016 U5 L1 – Home Living LTCS Level 1 | Medicaid | All | Per Event | $133.28 | $32.00 |
| T2016 U5 L2 – Independent Living LTCS Level 2 | Medicaid | All | Per Event | $164.87 | $39.59 |
| T2016 U5 L3 TL – Companion Living LTCS Level 3 Therapeutic Leave | Medicaid | All | Per Event | $178.58 | $42.88 |
| T2016 U5 L3 – Companion Living LTCS Level 3 | Medicaid | All | Per Event | $178.58 | $42.88 |
| T2016 U5 L4 TL – Supervised Living LTCS Level 4 Therapeutic Leave | Medicaid | All | Per Event | $193.72 | $46.52 |
| T2016 U5 L4 – Supervised Living LTCS Level 4 | Medicaid | All | Per Event | $193.72 | $46.52 |
| T2016 U5 L5 TL – Group Living LTCS Level 5 Therapeutic Leave | Medicaid | All | Per Event | $209.17 | $50.23 |
| T2016 U5 L5 – Group Living LTCS Level 5 | Medicaid | All | Per Event | $209.17 | $50.23 |
| T1019 U4 CR – (b)(3) Individual Support | Medicaid | All | 15 min. | $18.08 | $4.34 |
| T1019 U4 DJ – (b)(3) Individual Supports | Medicaid | All | 15 min. | $19.82 | $4.76 |
| T1019 U4 GT CR – (b)(3) Individual Supports | Medicaid | All | 15 min. | $16.46 | $3.95 |
| T1019 U4 TS – Individual Supports – Community Only | Medicaid | All | 15 min. | $16.46 | $3.95 |
| T1019 U4 – (b)(3) Individual Support | Medicaid | All | 15 min. | $18.08 | $4.34 |
Providers who would like to take advantage of the retroactive increased rate will need to submit a replacement claim for any claims previously submitted at the lower rate within the timely filing guidelines.
Alpha+ Provider Scheduler Changes
Partners is changing the process for providers and community agencies who continue to use the PartnersACCESS scheduler in Alpha+ beginning on Feb. 1, 2023.
The appointment scheduler was a system created for Partners to track follow up appointments per the N.C. Department of Health and Human Services (NCDHHS) requirements that have recently sunsetted as we transition to NC Managed Care. Very few providers and agencies currently use the scheduler.
Our process as of Feb. 1, 2023, is for PartnersACCESS to assist members, providers and community agencies with warm transferring to appropriate provider agencies for scheduling and if after hours, staff will provide caller with contact information to at least one potential agency.
Please direct any questions or concerns about this process to questions@partnersbhm.org or contact the PartnersACCESS Call Center at 1-888-235-4673.
State-funded Waitlist/Services Process Information Session
Partners will hold an information session on the state funded waitlist/services process for state-funded providers on Feb. 10, 2023, from 2 to 3 p.m.
This will be a pre-recorded broadcast providing an overview that covers the process for making a request and what happens after a request is made. A short question and answer period will be scheduled at a later date for follow up questions.
Click here to register.
Claims Information
Providers are reminded to contact the Claims Department at claimsdepartment@partnersbhm.org for all claims-related questions. To avoid delays in receiving a response, please do not contact individual Claims’ staff directly.
Alpha+ Portal University is an available resource and guide for navigating Alpha+. 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 requests copies of the Explanation of Benefits (EOB) for members’ claims submitted indicating Coordination of Benefits. The request will originate via email from Partners’ Claims staff. 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 and 193400000X
Taxonomy Code 193200000X and 193400000X 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.
Provider Payments
Partners is committed to paying claims in a timely manner and adheres to Prompt Pay Guideline Compliance as set forth by the state of North Carolina. In order to ensure that all providers receive EFT payments as outlined in signed contracts, providers are required to submit the proper financial documentation, which includes banking information. If you need to add new banking information or are requesting a change to current banking information, you may email acash@partnersbhm.org or call 704-884-2523.
| November 2022: Medicaid—Number of Days to Process and Pay All Claims | |
| Received Date to Paid Date: | 8.3 |
|
Top Five Medicaid Claim Denials for November 2022 |
|
| Claim Denial | Provider Recommended Action Steps |
| Service is not authorized | Verify Service Authorization for member. Contact Utilization Management. |
| Duplicate claim | The claim has previously been submitted and adjudicated. Do not refile. |
| Invalid rendering/attending provider NPI number. | Verify the rendering NPI is correct on the claim and is valid for service billed. |
| 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 the date of service submitted on the claim. If this appears to be correct, contact the Managed Care Organization (MCO) for further assistance. |
| Missing/incomplete/invalid diagnosis or condition. | Rebill the claim with a valid corresponding diagnosis code. |
State News and Updates
NCDHHS Resources:
- Joint Communication Bulletins, which are issued by the N.C. Department of Health and Human Services, can be found here.
- Medicaid Bulletins: All bulletin articles are available here. Providers are encouraged to frequently review this information.
- Medicaid Pharmacy Newsletters are available here.
- NCTracks: Providers are encouraged to review NCTracks communications. To subscribe to NCTracks communications, click here.
Training Resource and Collaborative (TRAC)
The TRAC offers a centralized cross-functional selection of required trainings, collaboratives and events. Click here to view what is coming up in the next few months.
Tailored Plan On-Demand Provider Trainings
The N.C. Department of Health and Human Services (NCDHHS) requires the listed trainings be available for providers. This applies to Tailored Plan, Medicaid Direct and State-funded providers. Registering is easy. You will be prompted to enter simple registration information. The on-demand training will then be available immediately or when your schedule allows. Note: Training Reciprocity Among Tailored Plans. NCDHHS is allowing the six LME/MCOs reciprocity for some Tailored Plan-required trainings. Click here for Alert issued Oct. 26, 2022.
Due Process
On-Demand (Register)
This on-demand webinar covers the following (but not limited to) four dispute types: Medicaid appeals, non-Medicaid appeals, Provider disputes, and Grievances.
EPSDT
On-Demand (Register)
In the EPSDT training, you will learn: What is EPSDT; Partners EPSDT requirements; Periodicity Schedule; Diagnostic and Treatment Components; Medical Necessity Review; Service Coordination (Vaccines for Children, Into the Mouths of Babes, and Developmental Delay and Referral to NC Infant-Toddler Program); and EPSDT components, diagnosis codes, modifiers, referrals, tracking, follow-up and outreach.
Fraud, Waste and Abuse
On-Demand (Register)
This webinar covers (but is not limited to) the following: Regulatory Compliance Program, Types of Health Care Industry Oversight, Partners Program Integrity Department, Program Integrity Department Function Highlights, What are Fraud, Waste and Abuse (FWA), Potential Areas or examples of FWA and the Impact of FWA on health care.
Into the Mouths of Babes (IMB)
On-Demand (Register)
The IMB program trains medical providers on how to provide preventative oral health services to Medicaid-insured children from tooth eruption to age 3 ½ (42 months). Goals of the program include preventing and reducing early childhood tooth decay and increasing referral of high-risk children to a dental home. This training is required before being permitted to receive reimbursement for IMB services.
Partners Hand Washing and Personal Protective Equipment (PPE)
On-Demand (Register)
This new provider required training is now available on-demand. Participants will gain an understanding of infection control using PPE and frequent handwashing.
Partners Infection Control: Home Care Settings
On-Demand (Register)
This new provider required training is now available on-demand. Participants will gain an understanding of infection control in the home care setting, which includes learning ways infections are transmitted, standard precautions and how to teach members about infection control procedures.
Partners Infection Control: Community Care Settings
On-Demand (Register)
This new provider required training is now available on-demand. Participants will gain an understanding of infection control in the community care setting, which includes learning ways infections are transmitted, standard precautions and how to teach members about infection control procedures.
Prevention and Population Health Management
On-Demand (Register)
Partners takes a population-based approach to improve the overall health of Medicaid members and State-funded recipients and collaborates with community partners on targeted initiatives. In this training, you will learn about: Partners Prevention and Population Health Core Philosophies, Program Goals, Partners Prevention and Population Health Approach, Provider Level Interventions and Partners Prevention and Population Health Programs Overview of Provider Expectations.
Provider Training-Live Virtual and/or Prerecorded
CBT Learning Community
Dec. 21, 2022, 2 p.m.-3:30 p.m.(Register)
Jan. 18, 2023, 2 p.m.-3:30 p.m. (Register)
Join like-minded 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.
What do we do in this learning community: self-care, reduce burnout, professional growth, connection to a community, explore evidence-based practices, gain a sense of mastery, invest in your own emotional bank account, improve in quality of care delivered, and learn and practice skills that are reimbursable.
NBCC CEs are not available for this session. If you need accommodations to participate in the session, please email training@partnersbhm.org.
NC-TOPPS Monthly Webinar
Jan. 4, 2023, 2 p.m.-2:30 p.m. (Register)
Please join us the first Wednesday of every month for new NC-TOPPS updates. This is also an opportunity for everyone to share new ideas, provide mini trainings as well as ask questions. Please let us know if you have any specific topics you would like us to discuss during the monthly meetings. For questions or comments for NC-TOPPS, email us at NCTOPPSQUESTIONS@partnersbhm.org.
Target Audience: Existing and new providers in the Partners Health Management network.
Provider Open House
Jan. 5, 2023, 9 a.m.-10 a.m. (Register)
The Provider Open House is a virtual event that occurs the first Thursday of each month from 9 a.m. to 10 a.m. and is open to new and existing providers in the Partners Health Management network. You can enter questions in the question/comment box during registration.
The Provider Open House begins promptly at 9 a.m. and is staffed by all the usual department representatives ready to respond to your questions. We ask that you use our Zoom Registration process in advance of the open house and add your question(s) directly into the Zoom Questions and Comments box. This effort on your part, will help us better help you. Of course, your questions are welcome during the open house as well. You may place them in the chat box upon entering the Zoom meeting. Our intention is to address your questions or concerns in a private one-on-one breakout room, and we understand that your question may require further follow-up. We look forward to your participation.
If you need accommodations to participate in the Provider Open House, please email training@partnersbhm.org.
Community Support Team (CST) Service Definition Training
Jan. 10, 2023, 8:30 a.m.-11:45 a.m. (Register)
Community Support Team (CST) is a behavioral health support service designed to help people experiencing severe mental illness develop recovery and resiliency-oriented skills. 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. In order to receive a training certificate, registrants will need to view the full webinar and pass a 10-question quiz with a score of 80% or greater.
Acceptance and Commitment Therapy (ACT) Training
Jan. 10 and 12, 2023, 9 a.m.-12:15 p.m. (Register)
Acceptance and Commitment Therapy (ACT) blends mindfulness and CBT to help people explore their values and commit to action. Trainer: Eric Ottinger
ACT training will take place on Tuesday and Thursday, Jan. 10 and 12, from 9 a.m. to 12:30 p.m. Both days will utilize the same training link. Participants must have audio and visual capabilities and be visible on camera for both sessions to receive credit. No Partial credit will be given.
NCSAPPB approval code 20-333-S
NBCC Approved for 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.
Diversity and Inclusion Collaborative – Quarterly
Jan. 12, 2023, 2 p.m.-3 p.m.
April 13, 2023, 2 p.m.-3 p.m.
This is a closed work group designed to bring awareness and increase conversations about diversity, equity and inclusion within the LME/MCO and provider agencies. It reviews and develops policies and procedures that promote best practices and works to remove systemic barriers to minority providers. To request more information about this work group or to learn how to become involved, please contact Vickie Smith, vsmith@infinitebeginningsnc.org.
Partners LGBTQ Collaborative
Jan. 19, 2023, 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, resource sharing and training needs. Please join us for this interactive session of learning and community.
CLAS Standards Training
Jan. 24, 2023, 9 a.m.-12:15 p.m. (Register)
Cultural Competency: CLAS Standards – The office of Minority Health has established Culturally and Linguistically Appropriate Services (CLAS) Standards to address health equity and improve outcomes. This training will review the standards themselves as well as tools and training materials available to providers at no cost. This session does not offer CE’s. If you need accommodations to attend this training, email training@partnersbhm.org.
Partners Provider Council
Jan. 27, 2023, 9:30 a.m. (Register)
The Partners’ Provider Council is a professional representative of and advocate 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. An intellectual and developmental disabilities (I/DD)/Innovations Provider Breakout Session will immediately follow this meeting.
Motivational Interviewing Training
Feb. 9 and 10, 2023, 9 a.m.-5 p.m. (Register)
Join Partners Training Academy for this two-day, interactive training that will cover the fundamentals of Motivational Interviewing (MI). This training will be facilitated by MINT trainer, Tami Grossens, and meets NC service definition training requirements.
This is a virtual live event, which will be held on Thursday and Friday, Feb. 9 and 10, from 9 a.m. to 5 p.m. You must attend both full sessions to receive credit. No partial credit will be given. CEs not given without visibility on camera. Driving is not permitted during Partners trainings.
This event is approved for 13 NBCC 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 to attend this training email training@partnersbhm.org.
State-funded Provider Information Session
Feb. 10, 2023, 2 p.m.-3 p.m. (Register)
Partners will have an information session on the state funded waitlist/services process for providers. This will be a pre-recorded broadcast providing an overview that covers the process for making a request and what happens after a request is made. A short question and answer period will be scheduled at a later date for follow up questions.
Twelve Step Facilitation Training
Feb. 14 and 16, 2023, 9 a.m.-12:15 p.m. (Register)
Join Partners for a live, virtual 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. Trainer: Eric Ottinger
Training will take place over two days on Tuesday and Thursday, Feb. 14 and 16, from 9 a.m. to 12:15 p.m. Participants must have audio and visual capabilities and be visible on camera for both sessions to receive credit. No Partial credit will be given.
NBCC and NCSAPPB 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.
Partners Licensed Independent Practitioner (LIP) Collaborative
Feb. 15, 2023, noon-1 p.m. (Register)
Partners quarterly updates and vital information is shared with LIP providers. Click on the register button to register for this virtual live event.
Partners Provider Forum – Quarterly
March 8, 2023, 1 p.m.-3 p.m. (Register)
Partners quarterly updates and vital information is shared with providers. Please click on the register button to register for this virtual live event.
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.
Mental Health 101
Dec. 16, 2022, 10 a.m.-noon (Register)
In this two-hour training, learn about some of the more common behavioral health disorders. The class includes information about treatment and what to do in a crisis.
Joint DMH/DD/SAS and DHB (NC Medicaid) Member Webinar
Dec. 19, 2022, 2 p.m.-3 p.m. (Register)
This webinar series is for members, family members, and community stakeholders to provide updates from the Division of MH/DD/SAS and Division of Health Benefits (NC Medicaid). The agenda includes:
- Tailored Plan Timeline and Milestones
- 1915(i) Benefits
Community Resilience Model® (CRM)
Dec. 19, 2022, 2 p.m.-4 p.m. (Register)
The Community Resilience Model® instructs 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.
QPR (Question, Persuade, Refer)
Dec. 20, 2022, 2 p.m.-4 p.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. After registering, you will receive a confirmation email containing information about joining the meeting.
Partners Community Café
Fourth Wednesday of each month, (Dec. 28, 2022), 10 a.m.-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. Community Café is held on the fourth Wednesday of each month. The December Community Café will highlight our Community Trainers and Geriatric Adult Specialty Team (GAST). Partners’ Community Trainers offer a wide variety of free virtual trainings that are open to anyone who would like to attend. Topics include suicide prevention, trauma, coping skills and child abuse prevention. Staff from GAST will share information and resources available for people who are aging and care for the elderly. We invite all attendees to ask questions and join us for open conversation.
An Introduction to Child and Family Teams: A Cross System Training from the Family’s Perspective (CFT Part 1)
Jan. 24-25, 2023, 9 a.m.-4 p.m. (Register)
CFT 1 is a two-day experiential training (when you register, you agree to attend both days) with a goal of providing an overview of Child and Family Team (CFT) 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
Hickory Brain Injury Support Group
Dec. 27, 2022, 6 p.m.-7:15 p.m.
Connect with survivors, families, and professionals. Meetings offer help, hope, and education, so you can live a happy and successful life after brain injury. This group meets on the fourth Tuesday of most months from 6 to 7:15 p.m. in the Community Room at First United Methodist Church, 311 3rd Ave NE, Hickory NC 28601. Times and locations sometimes vary. Meetings may occur online if there is a COVID-19 surge.
For more information, contact Travis Glass at 828-781-0778 or travis@crossroadscounseling.org. Also check facebook.com/HickoryBISG. Each meeting will be followed by 15 to 30 minutes of mindfulness awareness education and practice.
Disability Support Professional Training: Mount Eagle College and University is now offering Disability Support Professionals (DSPs) the opportunity to earn national certification in their field through an accredited curriculum instructed by individuals with lived experience. To learn more about the program, please email mjames@mounteag.com or visit https://mounteag.com/contact/ to submit a contact form.
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 a group or attending, please email Partners Community Engagement.
Select a county below to go to the associated collaborative information:
| – Burke
– Cabarrus – Catawba – Davie
|
– Forsyth
– Gaston – Iredell – Lincoln
|
– Stanly
– Surry – Union – Yadkin
|