Partners December Provider Webinar
Partners will host its next Provider Webinar on Wednesday, December 12 from 1 p.m.-3 p.m. To register for the webinar, click here. To view past webinars, slide decks, and handouts, please visit https://legacy.providers.partnersbhm.org/provider-webinars-forums/. If you have a question about the topics scheduled for discussion, or any provider operations matter, please email your question to questions@partnersbhm.org.
Provider Compliance Survey
We’d like some feedback from you, the provider, about compliance efforts within your organization. Partners’ Regulatory Compliance External Training Compliance and Awareness Sub-Committee asks that you take 10 minutes to complete our brief survey. Our goal is to apply the information submitted toward the development of external training opportunities focusing on needed areas, and in the format most convenient to providers. Thank you for your assistance!
1115 Waiver Timeline
On October 19, 2018, the NC Department of Health and Human Services (DHHS) received bids from potential prepaid health plans (PHPs). So, what are the next steps?
- DHHS will first review offers to determine that they are in the proper form and include all required documents. The Evaluation Committee will then screen the offers to determine if the minimum qualifications have been met.
- The Evaluation Committee will evaluate proposals meeting the minimum qualifications and develop consensus ratings, ultimately developing an award selection that is aligned with state law and will provide supporting documentation for their selection.
- DHHS will submit the contracts to the Federal Centers for Medicare & Medicaid Services for approval.
PHP contract awards are anticipated to be announced in February 2019. Once DHHS awards contracts to the selected health plans to be PHPs in managed care, the following will occur:
- Summer 2019—PHPs must have contracted with enough care providers for their network to meet DHHS standards.
- July 2019—PHPs must have all call centers operational and all relevant staff located in North Carolina.
- July-September 2019—Managed care will start in two phases. For regions of the state in Phase 1, this will be the window in which beneficiaries select a PHP.
- November 2019—The Medicaid managed care program will launch in regions in Phase 1.
- October-December 2019—For regions of the state in Phase 2, this will be the window in which beneficiaries select a PHP.
- February 2020—The Medicaid managed care program will launch in regions in Phase 2.
To make sure you are aware of the most up-to-date information about North Carolina’s Medicaid Transformation, please continue to visit https://www.ncdhhs.gov/medicaid-transformation.
Provider Credentialing
Recredentialing Dates Now Available: Provider agencies, clinicians, and licensed independent practitioners can now keep track of credentialing expiration dates via three reports that Partners has posted to Provider Credentialing and Enrollment page at https://legacy.providers.partnersbhm.org/provider-enrollment-credentialing/. The reports contain recredentialing dates for clinicians, licensed independent practitioners, and provider agencies credentialed in the Partners Network.
If you have questions regarding the reports, please contact the Credentialing Team at credentialingteam@partnersbhm.org or call 704-842-6483.
Provider Enrollment in AlphaMCS: Providers are reminded that credentialing and enrollment are two separate and distinct processes. In order to enroll a provider (agency, site or clinician) into AlphaMCS, Partners must verify that the provider is both
- credentialed with Partners and
- enrolled in NC Tracks.
The effective date of the enrollment in AlphaMCS is the earliest date that the provider is both credentialed with Partners and enrolled in NC Tracks. If Partners attempts to enroll a provider in AlphaMCS and is unable to verify your enrollment in NC Tracks, we will send you an enrollment status letter outlining the reason(s) why we cannot enroll you. It is the provider’s responsibility to notify Partners once the enrollment problems outlined in that letter have been resolved.
Information about the credentialing and enrollment processes was shared in Provider Communication Bulletin #86, published on October 18, 2018. For more information about the difference between credentialing and enrollment, please refer to our website at the following link https://legacy.providers.partnersbhm.org/provider-enrollment-credentialing.
Health Information Exchange/NC Tracks Updates
[alert style=”info”]All providers must be enrolled in NC HealthConnex by June 1, 2019 or have a State-Approved Extension by that date to continue to receive payment.[/alert]
Providers are reminded to pay attention to notifications from NC Tracks for the latest information regarding a variety of topics, including recredentialing and NC Health Connex. You can sign up for emails from NC Tracks by visiting https://www.nctracks.nc.gov/content/public/providers/getting-started.html.
2019 Checkwrite Schedule
The 2019 Checkwrite Schedule has been posted to the Partners’ Provider Knowledge Base at https://legacy.providers.partnersbhm.org/finance-documents-forms/.
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.
Timely Filing Override Requests: Please make sure claims are being submitted according to the timely filing guidelines available at https://legacy.providers.partnersbhm.org/claims-information/. If claims deny for any of the reasons below, make sure you submit timely filing override requests within the time frames. Timely Filing Requests should be sent directly to claimsdepartment@partnersbhm.org prior to submitting the claims.
AlphaMCS Portal University is an available resource and guide for navigating AlphaMCS. If you need additional claims training, email rcolvard@partnersbhm.org to schedule a time for training.
| Medicaid—October 2018: Number of Days to Process and Pay All Claims | |
| Received Date to Paid Date: | 8.7 |
| Top Five Medicaid Claim Denials—October 2018 | |
|
Claim Denial |
Provider Recommended Action Steps |
| Claim received after the billing period | Write off charges as non-billable. Do not rebill. |
| Invalid Units: Units claimed does not equal number of days for Discharge Claims. | Review the units billed and date range. Rebill with corrections. |
| Referenced claims has already been resubmitted. Multiple resubmissions are not allowed. | You can look in the Patient module to find all claims entered for that patient and see which are identical and when the claims were submitted. |
| Service is not authorized | Verify Service Authorization for the consumer. Contact Utilization Management. |
| The procedure code/bill type is inconstant with the place of service. | Contact the Claims Department at ClaimsDepartment@partnersbhm.org. |
National Hunger and Homelessness Awareness Week
This week, (November 10-18) is National Hunger and Homelessness Awareness Week (www.hhweek.org). At a time when most of us are planning for Thanksgiving, we should also pause and think of our neighbors who are experiencing hunger or homelessness. This is a week to draw attention to the problems of hunger and homelessness. Approximately 26 percent of homeless adults staying in shelters live with serious mental health issues (NAMI). Your organization may consider donating to a food drive or volunteering at a homeless shelter.
Each community is a part of a Continuum of Care (CoC) that creates partnerships to address the needs of homeless individuals. In Catawba County, visit www.housingvisionscatawba.org for information about their week of awareness events. In Burke County, an iCare Tour is offered annually in order to bring a hands-on approach and highlight the work that is being done. Contact your local CoC for ways to be a part of the solution. For more information, contact Bre Griffin, Housing Educator, at 704-884-2514 or bgriffin@partnersbhm.org.
Partners Training Academy Opportunities
All Partners Training Academy sessions are FREE to registered attendees. Be sure to register at www.PartnersTraining.org. If you have any questions about Partners Training Academy events, or would like to be added to the waiting list for a training that is already full, please email Training@PartnersBHM.org.
NC-TOPPS Discussion Webinar (Registration)
Wednesday, December 5, 2018, 2:00-2:30 p.m., Online Webinar
Description: The purpose of this webinar is to give super users the opportunity to discuss various topics pertaining to NC-TOPPS. The webinar will occur on the first Wednesday of the month. Please feel free to bring any questions or feedback that you would like to share with other super users and the Partners Quality Management team.
Trainer: Veronica Somerville, Quality Management Analyst
Looking for NC-TOPPS training? Partners has developed a recorded video to provide constant access to NC-TOPPS training. Please visit https://legacy.providers.partnersbhm.org/ for NC-TOPPS 101 & Superuser Training. Live webinar training is no longer offered on this topic.
Additional Training
Question, Persuade, Refer (QPR) Suicide Prevention Training (Registration)
Monday, December 3, 2018, 11 a.m.—1 p.m.,Foothills Higher Education Center Room 211, 2128 S. Sterling St. Morganton, NC 28655
Description: Participants of QPR (Question, Persuade, Refer) training learn to recognize warning signs of a suicide crisis and to question, persuade, and refer someone for help. Please attend this suicide prevention training and become a Gatekeeper for your community.
Trainer: Kim Rhoads, System of Care Liaison, Partners
Deadline to register is Wednesday, November 28, 2018
Youth Mental Health First Aid (Registration)
Wednesday, December 12, 2018, 8:30 a.m.-5 p.m., Hickory Regional Office
Description: Youth Mental Health First Aid is designed to teach parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human services workers, and other caring citizens how to help an adolescent (age 12-18) who is experiencing a mental health or addictions challenge or is in crisis.
Trainer: Kim Rhoads, System of Care Liaison, Partners
Child & Family Team 1 “An Introduction to Child and Family Teams: A Cross System Training from the Family’s Perspective” (Registration)
Monday, January 14, 2019, 9 a.m.- 4 p.m. and Tuesday, January 15, 2019, 9 a.m.-4 p.m., Elkin Regional Office
Description: CFT 1 is a two-day experiential training 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.
Trainer: Stephanie Funderburk, System of Care Liaison, Partners
Alerts and LME/MCO Joint Communication Bulletins
Provider Alerts are sent to all providers subscribed to receive Partners’ Provider Communications. Published alerts are available on the Provider Knowledge Base at https://legacy.providers.partnersbhm.org/provider-alert-archive/.
Alerts issued since the last Provider Bulletin:
October 25, 2018 – CMS Approves 1115 Application; DHHS Webinar on Friday
All LME-MCO Joint Communication Bulletins are located at http://www.ncdhhs.gov/divisions/mhddsas/joint-communication-bulletins. Joint Communication Bulletins issued since the last Provider Bulletin:
- #J309 – Submission of IPS Fidelity Evaluation Reports to LME-MCOs
- #J310 – Innovations Waiver Flexibility Due to Hurricane Florence—Update
- #J311 – Preview of Revisions to the IPS Service Definition
Providers are encouraged to review the monthly Medicaid Bulletin. Bulletins are posted at https://dma.ncdhhs.gov/documents/2018-medicaid-bulletin-and-index.
Announcements and Reminders
1915 Waiver Public Comment Period: The NC Division of Health Benefits (formerly the Division of Medical Assistance) has posted the following Medicaid State Plan Public Notices:
- Thirty-day posing for the 1915 (c) Waiver Draft, also known as the NC Innovations Waiver, for public comment through November 22, 2018.
- Thirty-day posting for the 1915 (b) Waiver Draft, for public comment through November 28, 2018.
To view the draft and learn how you may comment on the draft waiver, please visit https://medicaid.ncdhhs.gov/get-involved/nc-health-choice-state-plan.
Partners and NC MedAssist Bring Free Mobile Pharmacy and Health Care Resources to Burke County: Partners and NC MedAssist will hold a Mobile Free Pharmacy event in Morganton this Friday, November 16. The event is open to any low-income individual or family needing over-the-counter medications and free health screenings. The event will be held from 9 a.m.-2 p.m. at the Collett Street Recreation Center (200 Collett Street, Morganton, NC 28655). Identification is not required to participate.
Individuals will receive up to up to eight medicine cabinet items for their family/home. Additionally, participants will receive other free healthcare services like information on NC MedAssist Free Pharmacy Program and free health screenings. NC MedAssist’s overall goal is to help ease the burden for those who are making the choice between buying food or purchasing medication.
There are currently more than 6,600 people in Burke County that live below the federal poverty level and do not qualify for insurance. Last fiscal year, NC MedAssist dispensed over $63 million in free prescription medication statewide. For more information on the Mobile Free Pharmacy and NC MedAssist, please visit www.medassist.org.
Partners Provider Council: Due to the Thanksgiving holiday, Partners Provider Council will meet on Friday, November 30, 2018, at Partners Hickory Office, Basement Multipurpose Room. Providers meet from 9:30-10:30 a.m., and Partners employees join the meeting from 10:30 a.m.-12 p.m. The Partners Provider Council is a professional representative and advocate 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. All providers are welcome to attend Provider Council meetings. To learn more, please visit https://legacy.providers.partnersbhm.org/provider-council/.
Licensed Individual Practitioner (LIP) Collaborative: The LIP Collaborative met via webinar on Thursday, November 8, 2018, from 12-1 p.m. To view the webinar or print the presentation, please visit https://legacy.providers.partnersbhm.org/licensed-independent-practitioners-collab/.
Appointment Scheduling: Providers offering appointments through the AlphaMCS Slot Scheduler need to ensure that appointments are scheduled correctly. Please make sure that your appointments account for the:
- Correct operating hours over holidays and vacations.
- Type of funding and clients served (Medicaid or State).
Providers should upload appointments for the next month at least two weeks prior to the beginning of the month. In addition, please inform Access to Care if you are adjusting hours due to operational changes.
If you have any questions, please contact Access to Care at 1-888-235-4673.
Community Inclusion Offerings at Pinehurst Conference—I’m IN: Community Inclusion Launch:
Head to the i2i Annual Conference a day early to learn about “I’m IN: Community Inclusion”, a statewide initiative to promote and support innovative policies and practices that enhance opportunities for people with mental illness to fully participate in their community. This meeting will be held Tuesday, December 4, 2018 from 1-4 p.m. This meeting is intended for consumer organizations, advocacy groups, System of Care collaboratives, people with lived experience, MCO staff, Transition to Community Living representatives, Stepping Up Collaboratives, and others interested in helping achieve the goal of community inclusion. FREE meeting, but must register to attend (use attached form or register online https://reg.abcsignup.com/reg/event_page.aspx?ek=0004-0020-02aa8b3be22c4e23aae57ade399eaced).
NAMI NC Policy and Legislative Priorities Listening Tour: NAMI NC is gearing up for the 2019 North Carolina General Assembly’s legislative session, which officially begins on January 30, 2019, and wants its members to help put the pieces of the 2019 legislative agenda together. With the help of affiliates, members, and coalition partners, NAMI NC has created a comprehensive 2018-2022 Policy & Legislative Priorities platform that buttresses and helps to advance NAMI’s mission. Using its legislative priorities platform as a framework, NAMI NC wants to hear from its members about issues that they think are important to advocate for or keep at the forefront of policy work during the 2019 NCGA legislative session.
The Western Region 1 meeting will be held on Saturday, December 1, 2018 from 9:30-11 a.m. at Foothills Higher Education Center, 2128 Sterling Street, Morganton, NC 28655. RSVP online (preferred) no later than one-week prior to the session. Please visit https://goo.gl/forms/IRaWTMkYVwFm2mLy1 to RSVP online and select the session you are attending (multiple sessions are being held across the state).
For more information, contact Dr. Michelle Laws, Policy and Public Advocacy Specialist, at mlaws@naminc.org, or call 919-788-0801, ext. 4748.
Low-Income Services: Crisis Intervention Program—More Than $30 Million in Assistance Available for Families Who Need Emergency Help Heating Their Homes: NC DHHS is reminding North Carolinians that more than $30 million in funds are available for families who need emergency help heating their homes through the Crisis Intervention Program.
“As temperatures become colder, individuals become more susceptible to health-related issues,” said David Locklear, Deputy Director of Economic and Family Services in the Division of Social Services. “This funding can help assist eligible individuals and families experiencing potentially life-threatening emergencies.”
The federally funded program helps households with low incomes who have a life-threatening or health-related emergency due to a lack of heating. Each household is individually evaluated, and if determined eligible for assistance, payments are made directly to the household’s heating vendor.
To apply, individuals should contact their county department of social services. Applications will be accepted until funds are exhausted.
To be eligible, a household must:
- Have at least one U.S. citizen or non-citizen who meets the eligibility criteria
- Have income equal to or less than 150 percent of the federal poverty limit; for example:
- For a household of one, an income of $18,210 or less
- For a family of four, an income of $47,070 or less
- Have someone with a health-related issue that might be made worse without heat
- Have a utility bill that shows how much is owed to the utility company
- Be responsible for their heating cost
For more information on the program and eligibility, visit www.ncdhhs.gov/assistance/low-income-services/crisis-intervention-program.