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ProviderAlert
March 9, 2015
 
Information in this Alert:
  • CAQH ProView
  • Psychosocial Rehabilitation--Correction to Feb. 16, 2015 Alert
  • Don't miss tomorrow's Provider Forum!

CAQH ProView
CAQH transitioned its Universal Provider Datasource (UPD) to CAQH ProView on March 2, 2015.

 

In the new ProView system, practitioners will need to log-in to CAQH and complete the following steps:

 1.  Update their individual log in
 
2.  Complete the security questions
 
3.  Complete a state release

  

Please note that Smoky, the credentialing delegate for CenterPoint, Partners, and Smoky, must have continuous access to each credentialed practitioners CAQH application. The practitioner must complete the above steps in order for Smoky to access the practitioners CAQH application.

Follow Up Action Required!

Practitioners that are already credentialed and do not have a credentialing application in process will need to update their CAQH profile as indicated above no later than March 31, 2015. Practitioners that are currently in process for credentialing will need to complete this update IMMEDIATELY in order to prevent delays in the application process.

Please visit http://www.caqh.org/ for more information about CAQH ProView. Please send any questions to the Smoky credentialing team at credentialingteam@smokymountaincenter.com.

 

Psychosocial Rehabilitation (PSR)--Correction to Feb. 16, 2015 Alert
 
 

This is a correction to our February 16, 2015 Provider Alert regarding the number of hours billed in a week for PSR consumers.  Partners will continue to allow a maximum of 32 unmanaged hours per week, for both Medicaid and IPRS consumers.

 

In our previous alert, Partners misstated the 32-hour a weekhard limit for IPRS consumers receiving PSR.  Partners has communicated with NC TRACKS and the Division of Mental Health (DMH) to learn that NC TRACKS reflects a limitation of 32 units per day,not 32 hours per week, per provider per recipient.  


 

Going forward, for Utilization Management and Claims:
 

Medicaid:               
  • There is NO daily limit of 32 units (8 hours).
  • Medicaid consumers can receive up to 32 unmanaged HOURS a week (no authorization is required.)
  • If more than 32 hours a week are indicated, the providers will submit a service authorization request (SAR) and clinical justification to Partners Utilization Management for the additional hours.
  • If you exceed 32 hours a week without an authorization in AlphaMCS, claims will not process.

IPRS:

  • There IS a daily limit of 32 units (8 hours).
  • IPRS consumers can receive up to 32 unmanaged HOURS a week (no authorization is required) 
  • If more than 32 hours a week are indicated,the providers will submit a service authorization request (SAR) and clinical justification to Partners Utilization Management for the additional hours.
  • Claims will not process for more than 32 units (8 hours) per day
  • If you exceed 32 hours a week without an authorization in AlphaMCS, claims will not process. 

 

We apologize for any confusion this "units per day" versus "hours per week" misstatement may have caused.  As always, Partners welcomes your feedback and requests that you work with your assigned Provider Network Specialist on any further concerns.

 

Don't Miss Tomorrow's Provider Forum!
  
The March All-Provider Forum will be held Tuesday, March 10 beginning at 1 p.m. The forum will be held via videoconference at Partners' offices in Elkin, Gastonia, and Hickory. This forum will focus on NC-TOPPS.
  
Providers are asked to RSVP for the location they plan to attend.
To RSVP or learn more, click here.
  
About Partners Behavioral Health Management
Partners Behavioral Health Management (Partners BHM) provides local management of publicly-funded behavioral health services in Burke, Catawba, Cleveland, Gaston, Lincoln, Iredell, Surry, and Yadkin counties. Offices are located in Elkin, Hickory, and Gastonia. Individuals in need of behavioral health services can call our Customer Service Call Center 24 hours a day, seven days a week at 1-888-235-HOPE (4673).
  
Want to learn more about Partners? Visit www.PartnersBHM.org.

 


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