Issued: January 4, 2019
Rutherford County Mental Health LME/MCO Disengagement Plan
Rutherford County has announced that on December 28, 2018, its government was notified by the North Carolina Department of Health and Human Services (NC DHHS) Secretary Mandy Cohen, MD, MHP, that, in accordance with NCGS § 122C-115(a3) and the county disengagement rules, NC DHHS is approving Rutherford County’s realignment with Partners Behavioral Health Management (Partners) with an effective date of July 1, 2019. Click here to learn more.
Change in Psychological Testing Codes
Effective January 1, 2019, the American Psychological Association (APA) has released updated CPT codes for Developmental, Psychological and Neurological testing. Please refer to the APA link below for further information. https://www.apaservices.org/practice/reimbursement/health-codes/testing.
The following CPT Testing codes have been replaced: 96101, 96111 and 96118.
Partners will post an updated Benefit Plan to the Provider Knowledge Base within the next week that references the changes. Providers are advised to contact their Network Management/Provider Network Account Specialist to ensure access to updated CPT codes in the system. A listing of Account Specialist assignments can be accessed here.
Utilization Management Update: Service Code “All Services” Tied to Definition Outpatient Individual Therapy Not Functional
AlphaMCS is not allowing authorizations to be processed with outpatient codes associated with the service code “All Services”. All Services corresponds with the Outpatient Individual Therapy definition in AlphaMCS. We are asking that providers submit each individual code needed for that particular client (i.e. 90832, 90834, etc.) to avoid future claims issues until the problem can be resolved. Effective January 31, 2019, Utilization Management (UM) will no longer allow providers to submit retro service authorization requests (SARS) to recover lost billing for outpatient claims issues associated with “All Services”. Please submit each outpatient code individually until further notice.
If you have any additional questions, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.
Utilization Management Update: Notification regarding Service Authorization Requests (SARS) and Pass-throughs
AlphaMCS is not allowing some providers to bill for their pass-through period for certain services. Claims may be denied because of “no authorization” which is out of the norm. We are asking that all providers submit a “Notification SAR” to cover their pass-through period. A Notification SAR requires no clinical documentation. Indicate within the Justification for Service Request in the SAR that you are submitting a Notification SAR to cover pass-through. Pass-through is not reviewed for medical necessity and will be a non-clinical authorization approval. Effective January 31, 2019, Utilization Management (UM) will no longer allow providers to submit retro SARS to recover lost billing for pass-through issues. Please submit Notification SARS until further notice.
If you have any additional questions about Notification SARS, please contact the MHSU UM Workgroup at 704 842-6436.
Remittance Advice (RA) Checkwrite Date
The checkwrite date on the Remittance Advice (RA) in AlphaMCS for this week is dated January 3, 2019 instead of January 2, 2019 as stated on the 2019 checkwrite schedule. To view the checkwrite schedule, please visit https://providers.partnersbhm.org/finance-documents-forms/.