Issued: June 24, 2019
Attention All Providers Serving Rutherford County Members: Service Authorization Requests
On July 1, NC Tracks will assign the Medicaid Eligibility for Rutherford members to Partners. In addition, providers will need to begin enrolling all state-funded and enhanced Medicaid members as they show up for an appointment after June 30, 2019. The exception will be for members receiving a state-funded daily service. However, we need your assistance.
Partners will begin enrolling members whose services are funded through State Funding. Partners Utilization Management will enter all authorizations needed for members in order to eliminate any undue administrative burden onto providers. Partners has been given information about all authorizations that have been issued up to June 30, 2019. However, it is important that we have information about any unmanaged B3, State, or Medicaid Enhanced or Specialty services. With the exception of Basic Services, Partners needs to have the information for any unmanaged authorizations which need to continue after July 1, 2019.
Please complete the Unmanaged Authorizations Spreadsheet (click here for fillable spreadsheet) and return (via encrypted email) to Jennifer Shain at firstname.lastname@example.org. Partners encourages providers to continue to deliver service at the same rate as members received on June 30, 2019.
If you have questions, please contact Charity Bridges, Utilization Management Director by emailing email@example.com or calling 704-884-2637.
Research Based-Behavioral Health Treatment (RB-BHT)
Individuals accessing Research Based-Behavioral Health Treatment (RB-BHT) through the LME-MCO system will continue to use CPT Category III codes for RB-BHT for dates of service prior to June 30, 2019.
For dates of service on or after July 1, 2019, providers will need to start using the Category I code for claims submission and authorization requests. Utilization Management will automatically end date ABT codes for June 30, 2019. Providers with active ABT authorizations will be required to submit service authorization requests for RB-BHT codes effective Monday, July 1, 2019. When submitting a service authorization request for the RB-BHT crosswalk please indicate in the SAR Justification that the SAR is being submitted for “RB-BHT crosswalk”.
If you have questions please contact Jennifer Moore, UM Manager, at firstname.lastname@example.org or 704-884-2557.
LME-MCO Communication Bulletin #J326 outlines the RB-BHT crosswalk and can be accessed at https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-abuse/joint-communication-bulletins-2019#may-2019-(j325—j326)
NC Medicaid Webinar: NC Enrollment Broker
NC Medicaid is hosting a statewide webinar regarding the NC Enrollment Broker who will be helping with the implementation of Medicaid Managed Care. The webinar is for any who have interest in North Carolina’s transformation to managed care, including stakeholders, providers, agencies and vendors.
The webinar will be held Tuesday, June 25, 2019, 1-2:30 p.m.
To register: https://attendee.gotowebinar.com/register/4503072261349860107
Topics that will be covered in the webinar:
- How this transformation will affect the Medicaid population
- How this transformation will affect the Behavioral Health population
- Open enrollment dates
- Responsibilities of the prepaid health plans (PHPs)
- PHP comparison chart
- Role of the enrollment broker (EB)
- Partnership of the PHPs and EB
- Question and answer opportunity
Providers are reminded that Partners communicates essential operation info through the Provider Communication Bulletin and Provider Alert.
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