Partners’ September Provider Webinar
Partners held its quarterly Provider Webinar on Wednesday, September 11. Please visit https://legacy.providers.partnersbhm.org/provider-webinars-forums/ to view the webinar or slide deck.
If you have further questions about the webinar, please contact Beth Lackey at blackey@partnersbhm.org.
Measurement-Based Care
As referenced in Provider Communication Bulletin #96, it is Partners’ expectation that currently credentialed and contracted Network Providers will identify and use a Measurement-Based Care tool by November 1, 2019.
Partners will host a webinar regarding Measurement-Based Care on Wednesday, October 2, 2019. Details and registration information are posted in the training section of this bulletin.
In addition, we will continually share resources, such as the one below, in the bulletin and at https://legacy.providers.partnersbhm.org.
NC Medicaid Managed Care
Providers are reminded to frequently visit https://medicaid.ncdhhs.gov/providers to learn about events and access tools, the Provider Playbook and more to help transition to managed care.
SAVE THE DATE: NC’s Transition to Medicaid Managed Care: Navigating 42 CFR Part 2 Requirements
Background: NC Medicaid is preparing for the largest transformation in its history. On February 1, 2020 NC Medicaid will transition to a managed care service delivery model to serve the majority of its enrolled beneficiaries. Under NC Medicaid Managed Care, most Medicaid beneficiaries will be served by one of five prepaid health plans (PHPs), collectively known as the Standard Plan Option. For additional information about this transition, please click here or visit https://medicaid.ncdhhs.gov/providers.
Training Description: The NC Department of Health and Human Services (NC DHHS) will host two identical webinars to orient applicable providers on how NC DHHS, LME-MCOs and providers will navigate 42 CFR Part 2 requirements related to the transfer of beneficiary data during the transition to NC Medicaid Managed Care. This training will supplement additional guidance provided by the NC LME-MCO network to applicable providers. For more information about 42 CFR Part 2 and its applicability to a particular service, please click here.
Target Audience: Providers providing services covered by 42 CFR Part 2 to beneficiaries currently served by Partners Behavioral Health Management
Dates (same training, two options)
- Friday, September 27, 2019, 1:00 p.m.-2:00 p.m.
- Friday, October 11, 2019, 1:00 p.m.-2:00 p.m.
To Register: https://attendee.gotowebinar.com/rt/7163570444590312705
Additional Materials will be Provided to Registrants Prior to Training
For Questions about Registration: Please contact Christina Trovato at Christina.A.Trovato@dhhs.nc.gov
Provider Training Webinars: NC Medicaid has presented the following Provider Training Webinars. Providers can access them at any time by visiting https://medicaid.ncdhhs.gov/provider-playbook-training-courses.
MCT 101 – Provider Transition to NC Medicaid Managed Care 101
MCT 102 – Provider Payment and Contracts, NC Medicaid Managed Care 102
MCT 103 – Value-Based Payment and Quality Measurement in Medicaid Managed Care, NC Medicaid Managed Care 103
MCT 103 – Provider Policies, NC Medicaid Managed Care 104
MCT 105 – Beneficiary Policies, NC Medicaid Managed Care 105
MCT 106 – Behavioral Health Services: Standard Plans and Transition Period
MCT 107 – Contracting with AMH Practices
MCT 108 – Clinical Policies
MCT 109 – Healthy Opportunities
MCT 110 – Overview of Long-Term Services and Supports Populations
MCT 111 – Care Management for Long-Term Services and Supports Populations
MCT 112 – Supporting the LTSS Community Through the Transition to Managed Care
MCT 113 – Care Management under BH I/DD Tailored Plans: Information for Providers
MCT 114 – NC’s Transition to Managed Care: The Crossover Series
MCT 115 – NC’s Transition to Managed Care: The Crossover Series Continued
Thursday, Sept. 19, 2019 from 1-2 p.m.
This is a continuation of the session on Sept. 5, 2019, providing a brief review of topics previously covered and additional guidance for supporting beneficiaries through the transition to Medicaid Managed Care.
Register
The following information was released by NC Medicaid:
Enrollment Broker Provider Directory Updates: The Enrollment Broker has implemented updates to the Provider Directory search on their website intended to provide more accurate information when searching for a practice. Issues and planned changes with the Provider Directory were communicated in a September Medicaid Special Bulletin.
NOTE: the references below that refer to “PCP” include:
- AMH-tiered practices/groups;
- AMH-tiered sole practitioners;
- Non-AMH-tiered practices/groups/sole practitioners that are contracted as a PCP by a PHP; and
- Medicaid Direct CA and CCNC enrolled practices/groups/sole practitioners.
Changes have been implemented and are summarized here:
- Searching for providers will be limited to include results for PCP’s only;
- Searching on non-PCP will no longer return search results;
- Individual providers (other than PCP sole practitioners/CA/CCNC) will no longer return search results; and
- Searching for a practice/group/sole practitioner was enhanced to return results based on the NCTracks Service Location Name, Doing Business As (DBA) Name, or Organization Name – in that order, so searches will utilize the more commonly-known practice name.
Q: If a beneficiary can’t find an individual rostered PCP doctor does that affect their selection or assignment as their PCP?
A: No, the beneficiary does not select an individual rostered doctor as their PCP, they select the PCP (according to the definition of PCP above). That’s how it works in NC FAST for Medicaid Direct PCP selection today. If a beneficiary cannot find a PCP by their practice name, they should try a search by the individual name or contact the Enrollment Broker Call Center for assistance.
More information about issues with the Enrollment Broker Provider Directory are available in the:
- Enrollment Broker Provider Directory fact sheet; and
- Medicaid Managed Care Provider Issues and Resolutions Overview
Thank you for your continued partnership in transitioning North Carolina to Medicaid Managed Care.
Social Determinants of Health (SDOH) – Assisting Members to Identify and Address Unmet Social and Environmental Needs
In “We Can Do Better – Improve the Health of the American People,” The New England Journal of Medicine, Sept. 2007, S. Schroeder reported that “only 10% of health outcomes are attributable to medical care, while up to 70% are tied to social and environmental factors and the behaviors influenced by them.”
The NC Department of Health and Human Services is looking “beyond what is typically thought of as health care and investing more strategically in health…and its interface with our social services systems – to address these realities. SDOH disproportionately impact Medicaid beneficiaries, negatively impact health and drive higher health costs.”
The National Quality Forum, of which Partners is a member organization, convened the National Quality PartnersTM SDOH Data Integration Action Team to promote collaboration and accelerate SDOH data integration into care and eliminate disparities. As one of 41 member organizations across the country, Partners’ Director of Integration and Development, Allison Gosda was part of the Action Team that developed priority challenges as well as a Call to Action.
The Action Team is calling for communities, providers, payers and federal agencies to collaborate and address the challenges to improve person-centered care and health outcomes through SDOH data integration. First and foremost of the recommended actions is to standardize and share data by capturing meaningful, standardized and locally actionable data. As such, Partners is working with Network Providers to meet our strategic goal of performing SDOH assessments for 80% of adult Medicaid members who have a SMI by June 30, 2020 and have the deficits addressed in a plan if the member indicates that three or more needs are current.
It is imperative that all Network Providers who serve adults in the target population respond to the Call to Action and participate in completing the assessment tool, addressing identified deficits. Partners Integration and Development Department is reaching out to providers to discuss the logistics of performing the assessment. In the meantime, providers are strongly encouraged to contact Judy Dahlstrom at jdahlstrom@partnersbhm.org to learn more and participate as we do more to improve lives and strengthen communities.
Unmanaged Basic Outpatient Services Code List
On July 15, 2019, Partners announced that it would no longer manage Basic Outpatient Services, and included this information in Provider Bulletin #95. On July 23, 2019, issued a second alert stating that the change was effective beginning with dates of service July 1, 2019.
The following table contains a revised list of Unmanaged Outpatient Basic Codes effective with Dates of Service July 1, 2019. No claims need to be re-submitted at this time. If you have questions, please reach out to the Utilization Management Workgroup at 704-842-6436.
| Unmanaged Outpatient Basic Codes | ||||
| Code | Modifier 1 | Modifier 2 | Modifier 3 | Description |
| 90791 | 90791- Psychiatric Diagnostic Evaluation (No Medical Services) | |||
| 90791 | BT | 90791BT- Psychiatric Diagnostic Evaluation | ||
| 90791 | DJ | 90791DJ- Psychiatric Diagnostic Evaluation | ||
| 90791 | GT | 90791GT- Assessment/Intake Codes | ||
| 90792 | 90792- Psychiatric Diagnostic Evaluation With Medical Services | |||
| 90792 | DJ | 90792DJ- Psychiatric Diagnostic Evaluation | ||
| 90792 | GT | 90792GT- Assessment/Intake Codes | ||
| 90832 | 90832- Psychotherapy – 30 Minutes | |||
| 90832 | AH | 90832AH – Psychotherapy – 30 Minutes | ||
| 90832 | BT | 90832 BT – Psychotherapy – 30 Minutes Brief | ||
| 90832 | GT | 90832 GT- Outpatient Individual Therapy | ||
| 90832 | TU | 90832TU – TFU – Psychotherapy – 30 Minutes | ||
| 90833 | 90833 Psychotherapy 30 Minute Add on to E&M | |||
| 90833 | GT | 90833 GT – Psychotherapy 30 Minute Add on to E&M | ||
| 90834 | 90834- Psychotherapy – 45 Minutes | |||
| 90834 | AH | 90834AH- Psychotherapy – 45 Minutes | ||
| 90834 | BT | 90834 BT – Psychotherapy – 45 Minutes Brief | ||
| 90834 | GT | 90834 GT- Outpatient Individual Therapy | ||
| 90834 | TU | 90834TU – TFU – Psychotherapy – 45 Minutes | ||
| 90836 | 90836 – Psychotherapy – 45 Minute Add on to E&M | |||
| 90837 | 90837 – Psychotherapy – 60 Minutes | |||
| 90837 | BT | 90837 BT – Psychotherapy – 60 Minutes Brief | ||
| 90837 | FN | 90837 FN – Psychotherapy 60 Min Family Net | ||
| 90837 | GT | 90837GT – Psychotherapy – 60 Minutes | ||
| 90837 | SR | 90837SR -Psychotherapy 60 minutes | ||
| 90837 | SR | FN | 90837 SRFN – Psychotherapy 60 Min In-Home Family Net | |
| 90838 | 90838- Outpatient Individual Therapy add-on with E& M code | |||
| 90839 | 90839- Outpatient Individual Therapy add-on 30 mins crisis intervention | |||
| 90840 | 90840- Outpatient Individual Therapy add-on 30 mins crisis intervention | |||
| 90845 | 90845 – Psychoanalysis | |||
| 90846 | 90846 – Family Therapy Without Patient | |||
| 90846 | FN | 90846 FN – Family Therapy Without Patient – Family Net | ||
| 90846 | SR | 90846 SR – Family Therapy Without Patient | ||
| 90847 | 90847 – Family Therapy With Patient | |||
| 90847 | FN | 90847 FN – Family Therapy With Patient Family Net | ||
| 90847 | SR | 90847 SR -Family Therapy With Patient | ||
| 90849 | 90849 – Multi-Fam Group | |||
| 90853 | 90853 – Non Family Multi Group Therapy | |||
| 90875 | 90875- (Interactive Complexity add-on code) Assessment Interactive | |||
| 96110 | 96110 – Devel Tst Lmt | |||
| 96112 | 96112- Developmental Testing | |||
| 96113 | 96113- Add-on Developmental Testing | |||
| 96116 | 96116 – Neurobehavioral Exam | |||
| 96121 | 96121 – Neurobehavioral Exam Add 1 Hr | |||
| 96125 | 96125 – Standardized Cognitive Performance Testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test result | |||
| 96130 | 96130 – Psychological Evaluation and Interpretation | |||
| 96131 | 96131 – Psychological Evaluation and Interpretation Add 1 Hour | |||
| 96132 | 96132 – Neuropsychological Eval & Interpretation | |||
| 96133 | 96133 – Neuropsychological Eval & Interpretation Add 1 Hour | |||
| 96136 | 96136 – Psychological Scoring Physician | |||
| 96137 | 96137 – Psychological SC Physician Add 30 | |||
| 96138 | 96138 – Psychological Scoring Technician | |||
| 96139 | 96139 – Psychological Scoring Technician Add 30 | |||
| 96146 | 96146 – Psych or Neuro Test Administered by Electronic Platform | |||
| T1023 | T1023- Diagnostic Testing | |||
| T1023 | GT | T1023GT- Diagnostic Testing | ||
| YP830 | YP830- Alcohol And/Or Drug Assessment | |||
| YP831 | YP831- Behavioral Health Counseling | |||
| YP832 | YP832- Behavioral Health Counseling – Group | |||
| YP833 | YP833- Behavioral Health Family Ther W/ Client | |||
| YP834 | YP834- Behavioral Health Family Ther W/O Client | |||
| YP835 | YP835- Alcohol And/Or Drug Group Counseling | |||
| 90837 | EM | 90837EM- EMDR | ||
| 90837 | Z1 | 90837Z1- Psychotherapy Traum Focused 60 Minutes | ||
| 90846 | Z1 | 90846Z1- Family Therapy Without Patient | ||
| 90847 | Z1 | 90847Z1- Family Therapy With Patient | ||
Claims Information
Increase in Hospital Claim Denials: Partners has seen a recent increase in hospital claim denials due to other providers billing for services when the member has been admitted for hospital inpatient services. Please verify that claims are not being submitted for dates of service when members are hospitalized. Service Codes frequently causing the denials include:
- H0019 (modifiers)
- S5145 (modifiers)
- YP710
Providers should send all inquiries to claimsdepartment@partnersbhm.org so 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 rcolvard@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.
| Medicaid—August 2019: Number of Days to Process and Pay All Claims | |
| Received Date to Paid Date: | 9.1 |
| Top Five Medicaid Claim Denials—August 2019 | ||
|
Claim Denial |
Provider Recommended Action Steps |
|
| Invalid DCN (Document Control Number) or Resubmission Reference Number | Review the RA (Remittance Advice) with the original claim number and make sure it was entered correctly. | |
| Duplicate Claim | The claim has previously been submitted and adjudicated. Do not refile. | |
| Service is not authorized | Verify Service Authorization for the consumer. Contact Utilization Management. | |
| 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 MCO for further assistance. | |
Partners Licensed Independent Practitioners Collaborative
Partners’ Licensed Independent Practitioners Collaborative will meet via webinar on September 26, 2019, from 12 p.m.-1 p.m. To register, click here.
To learn more about the collaborative, please visit https://legacy.providers.partnersbhm.org/licensed-independent-practitioners-collab/.
Partners Training Academy
All Partners Training Academy sessions are free to registered attendees. Register in advance at www.PartnersTraining.com. If you have any questions about Partners Training Academy events, please email Training@PartnersBHM.org.
Provider Orientation
9:00 a.m. – 12:00 p.m., Gastonia: October 3, November 7, December 5 (click a date to register)
Description: Join Partners’ Provider Network, Claims, Access to Care, Utilization Management, Care Coordination, and Quality Management staff for an interactive provider orientation. These open-house style events will allow attendees time to work one-on-one with Partners’ staff to discuss any issues or unfamiliar topics. Participants are encouraged to bring their own laptops to access and review their specific workflow.
These sessions will reoccur monthly on the first Thursday of each month from May – October 2019 (excluding the month of July due to the Independence Day holiday).
These training sessions are open-house style with no formal presentation or start time. As a registered attendee, you are welcome to arrive and exit at your convenience, depending on the amount of time you feel is needed with our staff. The intended audience for these orientations is not limited to only providers who are new to Partners’ network, but it is advised that attendees already have access to AlphaMCS prior to attending a session.
Measurement-Based Care Webinar
Date, Time and Location: Wednesday, October 2, 2019, 1:00 p.m. to 3:00 p.m. (Registration)
Description: As Partners prepares the Provider Network to be positioned to work within both a standard plan and tailored plan environment, it is critical that providers are using a measurement-based care tool and can demonstrate a data sample from the use of that tool. While you as a provider may be in the process metric category, the use of the tool is key and the measurement conducted frequently, using the tool, is critical to move towards population health management. As this is such a critical area in improving the quality of the care and improving the lives of the members served, it is Partners expectation that currently credentialed and contracted Network Providers identify and use a Measurement-Based Care tool by November 1, 2019.
Trainers: Gina Lasky, PhD, MAPL, and Lori Ramey, Health Management Associates.
Child and Family Team – 1 “An Introduction to Child and Family Teams: A Cross-System Training from the Family’s Perspective”
Date, Time and Location: Monday and Tuesday, October 23 – 24, 2019, 9:00 a.m. to 4:00 p.m., (Registration)
Catawba County Life Skills Facility, 3060 11th Avenue Dr. SE, Hickory, NC 28602
Description: 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.
Trainers: Kim Rhoads, MA, LCAS, and Jeanne Patterson, BA, QP, SOC
Community Training Coordinators, Partners Behavioral Health Management.
Please register by Friday, October 18, 2019
Register online and find additional training opportunities at www.PartnersTraining.org.
Alerts and LME/MCO Joint Communication Bulletins
Provider Alerts are sent to all providers who subscribed to receive Partners’ Provider Communications. Published alerts are available on the Provider Knowledge Base at https://legacy.providers.partnersbhm.org/provider-alert-archive/. To subscribe to Partners’ various communications, please visit https://www.partnersbhm.org/subscribe/.
Alerts issued since the last Provider Bulletin:
September 5, 2019 – Hurricane Dorian Provider Support Request, Procedures
September 9, 2019 – CTIA Rate Update; Revision to July 15, 2019 Alert
Joint Communication Bulletins, which are issued by the NC Department of Health and Human Services, can be found at https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-abuse/joint-communication-bulletins-2019.
Providers are encouraged to review the monthly Medicaid Bulletin. Bulletins are posted at https://medicaid.ncdhhs.gov/providers/medicaid-bulletins.
Training, Announcements and Reminders
Free Medication Assisted Treatment Training Available:
The National Health Service Corps is partnering with the Substance Abuse and Mental Health Services Administration (SAMHSA) to increase the number of DATA 2000 Waiver-certified clinicians in high-need communities. SAMHSA’s Provider Clinical Support System (PCSS) offers the most effective, evidence-based clinical practices in preventing, identifying, and treating Opioid Use Disorder (OUD) and Substance Use Disorder (SUD).
PCSS provides training for the Drug Addiction Treatment Act of 2000 (DATA 2000) Waiver, which helps improve access to OUD and SUD treatment by allowing clinicians to dispense or prescribe narcotic medications like buprenorphine in settings other than an opioid treatment program (OTP).
To learn more or access the training, please visit https://pcssnow.org.
Participation Requested:
The Center for Child and Family Health and the Dept. of Mental Health are conducting a statewide needs assessment of mental health services for children and youth in North Carolina. The project will help us better understand barriers to/facilitators of the use of trauma-informed screening and assessment in order to tailor future training efforts to the needs of each community and the state as a whole.
We would greatly appreciate your participation in our survey. It should take approximately 15-20 minutes for mental health providers to complete. The survey will close at 5 p.m. EDT on 9/20/19.
https://duke.qualtrics.com/jfe/form/SV_bKJ5AdI6ce2r4Gh
2019 NAMI North Carolina Statewide Conference:
The 2019 NAMI North Carolina Annual Conference will be held on October 11, 2019, at the McKimmon Center in Raleigh, North Carolina. At this year’s Conference, we will explore the theme of “Amplifying Voices: Advocacy, Recovery, Transformation.” We are looking to provide experiences for attendees to come to a deeper understanding of how we can all amplifying our voices to improve the lives of those affected by mental illness. In addition to various speakers and breakouts sessions, NAMI NC is pleased to welcome various artists to showcase their talents and demonstrate how art can play a role in mental health at this year’s conference.
Registration for the conference includes lunch, parking, and access to all workshops and exhibits. Members will be invited to attend the annual meeting in the afternoon. CEU’s will also be available. To learn more or to register, please visit https://naminc.org/nami-north-carolina-events/8584-2/.