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| Alpha eTraining Videos with Closed Captions | Closed Captions Available
Smoky Mountain Center has recently added the ability to display the AlphaMCS Provider Portal eTraining videos with closed captions. Closed captions are a text version of the spoken part of each of the videos. Closed captioning was developed to aid hearing-impaired people, but it's useful for a variety of situations. For example, captions can be read when audio can't be heard, either because of a noisy environment or your laptop/PC does not have the proper audio equipment or because the audio may disrupt a work environment.
If you would like to use this new closed captions functionality, you will need to view the videos in Google Chrome. Google Chrome is a freeware web browser developed by Google. Learn how this works. |
| Training - Integrated Care and Recovery | |
Date: April 7, 2014
Time: 9:00 - 5:00
Location: Western Carolina University in Cullowhee
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| Claification on Therapeutic Leave | |
Attn ICF - IID Providers
Please note that Therapeutic Leave does not require prior authorization. Per Clinical Coverage Policy 8E, residents are allowed to take up to 60 calendar days of therapeutic leave in any calendar year. However, if therapeutic leave in excess of 15 consecutive days is needed, please contact Rachael Smith, IDD UM Manager, for verbal approval at 828-586-5501 x. 1139.
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| Provider Claims Dump File | | Attn: All Providers
AlphaMCS has a Portal Claims Dump file available for providers in the Download Queue. This data dump is not intended for reporting purposes or to replace Remittance Advices or 835 files, but is a tool to research what happened to each and every claim submitted regardless of adjudication reason status. It is important to understand that this is an ongoing dump that is updated every morning to list the status of every claim submitted, including refilled claims. If there is a denial on the list it will continue to remain on the list along with any rebills or replacement claims submitted and processed.
Please be advised that a change will be made to the SMC Provider Claims Dump file available in the Download Queue of the AlphaMCS Provider Portal. The Claims Dump file currently hold 12 months of provider claims history. Effective May 1, 2014, the Claims Dump file will be reduced to six (6) months worth of data. This is in order to reduce the size of the files that are produced and to lessen the load on the system. We recommend that providers who wish to retain information beyond the most recent six months access the file prior to May 1 and save it to their local network.
More information available at the AlphaMCS University link: http://www.alphacm.net/portaluniversity/ in the Download Q document. Please note that the other Dump Files for Consumers and Service Authorizations will not be impacted by this change on May 1, 2014. |
| School-Based Mental Health Survey | |
Dear School-based Providers,
The Department of Health and Human Services, the Department of Public Safety, and the Department of Public Instruction are collaborating in an effort to address school safety. One of the Governor's Task Force for Safer Schools' steering committees is focused on mental health and students with special needs.
The following 7 question survey will provide necessary information about the current status of services being provided in NC schools. Please complete the survey if you have not already done so and/or forward it to your school-based clinicians. Thank you very much for your participation! https://www.surveymonkey.com/s/6V8WWXD
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| Change in Handling of Service Authorization Requests (SARS) | |
Effective April 1, 2014
Effective April 1st, 2014, there will be a change in how care managers respond to invalid or incomplete requests. As a reminder, we cannot process invalid or incomplete requests. View a summary of the changes.
With regard to administrative denials, if required documents are not provided in the SAR or uploaded into Alpha, Care Managers will attempt to contact the provider to obtain the needed information. Please ensure that the contact name and number that you provide in the SAR Justification Statement is accurate and is for a staff member that can provide clinical information about the consumer. In addition to attempted phone contact, Care Managers will post a comment attached to the SAR that requests the missing information.
If you receive a phone call from a care manger asking for documents
PLEASE CALL BACK BY THE DEADLINE PROVIDED IN THE MESSAGE TO AVOID AN ADMINISTRATIVE DENIAL.
Note: If a SAR has been administratively denied or sent back as Unable to Process, the corrected SAR may not be submitted for a retroactive service date. Please submit requests at least 14 days in advance of the desired service start date to allow adequate time for SAR processing.
If you have any questions we are here to help. Please call the care management line 828-586-5501 x1902 for any questions about requirements, the approval process, and Clinical Coverage Policy. For questions about how to upload documents, or for questions about working in the Alpha system, please call the SMC Helpdesk 586-5501 x1500.
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| SMC Training - Person Centered Thinking | |
Dates: May 22-23 (9:00 - 4:00 both days)
Presenter: Greta Byrd, SMC Training Manager
Cost: This is a 2-day workshop/$20 registration fee
Location: WCU Campus at Biltmore Park
28 Schenck Pkwy. Suite 300 (Room 338)
Asheville, NC 28803
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| Attn: All Providers | |
Update: Smoky Mountain Center (SMC) Peer Review Process
Initial Peer Reviews are conducted when making medical necessity determinations to approve or deny services, and Reconsideration Peer Reviews (appeals) are conducted to determine whether denial decisions are upheld or overturned.
SMC Care Managers review service authorization requests (SARs) to determine whether they meet administrative and medical necessity requirements. When Care Managers find that medical necessity requirements may not be met for authorization requests, they refer the request to a Peer Reviewer to make that determination. Per Medicaid requirements, only a licensed Psychologist or Physician may make a medical necessity denial decision.
Peer Reviewers review the SAR and the information submitted with it when making medical necessity determinations. This may include a Person Centered Plan, Comprehensive Clinical Assessment, or other information submitted by the provider or requested by a Care Manager. Additionally, the Peer Reviewer may talk with the Provider to obtain additional information or to better understand the information submitted.
To facilitate communication with SMC about SARs, please put the name of the individual who is providing the service or who is most knowledgeable about the case, along with that person's telephone number, at the end of the Justification for Service Request field when submitting SARs.
When conducting peer-to-peer reviews, Peer Reviewers call the Provider and identify themselves as calling on behalf of SMC to discuss an authorization request for the consumer that they identify. If unable to contact the appropriate Provider representative on the first attempt, a Peer Reviewer may try again to make contact at a later time. However, because of the tight turn around time requirements for authorization decisions, the window to conduct peer-to-peer discussions is usually short. If the Peer Reviewer tries but does not succeed in talking to the Provider, he or she will make a medical necessity determination based on the information submitted with the SAR. For that reason, we encourage Providers to submit any additional information that will help explain the medical necessity of the service with the SAR.
SMC uses both staff Peer Reviewers and Peer Reviewers with BHM, a company contracted to conduct Peer Reviews on behalf of SMC. SMC has a Business Associate Agreement with BHM, and providers are permitted to discuss SMC cases and share clinical information with BHM reviewers the same as they do with SMC staff.
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| NC Youth Leadership Forum - Apply today! | | Learn more about the YLF Forum Dates: July 14-18
The North Carolina Youth Leadership Forum for 2014 WILL BE HELD
July 14-18, 2014 at North Carolina State University. Twenty delegates will be selected, four group leaders, and tons of volunteers are needed!!
Applications are due by March 28, 2004
Please encourage all young people 15-28 years old with a disability that live in North Carolina to apply. They can complete the application and submit it by mail, email, or call and ask for other accommodations as needed. We accepted video applications, voice recorded applications, paper, and electronic applications by post-marked by March 28th, 2014.
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| Attn: All Service Providers: | |
SARS for Basic Benefit and Enhanced Services (IPRS/Medicaid)
Effective 10/1/2013, all Service Authorization Requests (SARS) for Basic Benefit and Enhanced services for both IPRS and Medicaid funded consumers MUST be accompanied by the appropriate leveling tool scores for medical necessity reviews. LOCUS and CALOCUS scores will be required for all mental health services and ASAM for substance abuse service authorization requests. All SARS submitted without the appropriate leveling tool will be pended and the leveling tool will be requested. If the tool is not returned within the 14-day required time frame, the request will be DENIED. It is recommended that the scoring worksheet be uploaded in Alpha so that medical necessity criteria for the requested service can best be facilitated.
For those consumers receiving services through Comprehensive Providers not requested SARS, it is the expectation that the provider will utilize the appropriate leveling tool at the time of assessment and throughout treatment to ensure that consumers are receiving the appropriate level of care and to facilitate ease of transition when consumers switch funding sources.
Upcoming Trainings - April 16, 2014
For SMC's LIPs who have not yet received training on LOCUS/CALOCUS, please register the one of the following trainings:
LOCUS Training: 9:00 - 12:00
CALOCUS Training: 1:00 - 4:00
Location: Asheville Office, Board Room
356 Biltmore Ave, Asheville, NC 28607
Trainer: Elizabeth Burgess, Clinical Training Specialist, Ext. 5911
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| Provider Recoupments due to Notices of Overpayment | |
There are times when SMC determines that providers have received overpayments. Generally, this occurs as the result of a Provider Network or Program Integrity investigation. It is critical that the instructions regarding repayment found in the notice of overpayment be followed in order for providers to receive proper credit for any recoupment or payback.
When notified of an overpayment, the provider is to remit the overpayment amount by to SMC by check. To assure the payment is properly credited, please enclose the any attached payment form that accompanies the notice of overpayment with the check. If you would like to request that overpayment be recovered from claim payments or approval for a payment plan (not to exceed 24 months), that MUST be done through the Chief Finance Officer (CFO). Instructions for this request process are contained in the letter. Failure to work with the CFO to arrange for recoupment by means other than a check may result in problems properly crediting the recoupment. It is important to note that if the recoupment is not properly credited certain processes, such as credentialing, may be delayed while the credentialing staff investigates the situation. |
Attn: Assertive Community Treatment Team
(ACTT) Providers | |
Reimbursement Rate Increase
Effective for dates of service on and after April 1, 2014, the Smoky Mountain Center MCO reimbursement rate for the Assertive Community Treatment Team (ACTT) service will increase by 3%, from the current rate of $295.32 per unit to $304.18 per unit. There will be no changes to the procedure code billed, therefore the maximum number of units paid per month is 4. This increase applies to both Medicaid and State Benefit Plans. Providers are reminded that SMC pays the lesser of the contract rate and the amount claimed, and should increase their charges to reflect the increase.
Initial SARs
The following is a list of documentation that should be submitted with initial SARs submitted with dates of service on or after April 1, 2014:
- Comprehensive Clinical Assessment (CCA)
- Person-Centered Plan (PCP) with signed Service Order and Comprehensive Crisis Plan (if applicable)
- LOCUS worksheet - posted on SMC website
- ATR Scoring Sheet - recommended template is posted on SMC website. Alternatives can be submitted if approved by SMC Manager of Adult Care Management, Laura Woodrup.
Phone: (828-586-5501 x 5152
Email: laura.woodrup@smokymountaincenter.com)
Web: http://www.smokymountaincenter.com/authinfo.asp
Re-authorization SARs
The following is a list of documentation that should be submitted with re-authorization SARs submitted with dates of service on or after April 1, 2014:
- Updated Person-Centered Plan (PCP) with signed Service Order and Comprehensive Crisis Plan (if applicable)
- LOCUS worksheet - posted on SMC website
- ATR Scoring Sheet - recommended template is posted on SMC website. Alternatives can be submitted if approved by SMC Manager of Adult Care Management, Laura Woodrup.
Phone: (828-586-5501 x 5152
Email: laura.woodrup@smokymountaincenter.com) - Number of Contacts Worksheet - posted on SMC website
- Transition Plan which should include the following elements: anticipated date, transition service, barriers to transition, and ancillary needs. The transition plan can be a separate document that is generated by the provider, or it can be addressed in the clinical justification section of the SAR.
Web: http://www.smokymountaincenter.com/authinfo.asp
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| Training - Stewards of Children Progarm | |
Help Children stay safe from sexual predators
Increase Your Awareness to Prevent Child Sexual Abuse
Free workshop for parents, staff, and volunteers advocating for children
Date: April 17, 2014
Location: 895 State Farm Rd, Boone - 500 Building, small meeting room
Time: 1:00 - 4:00 pm
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| Benchmark Training - Person Centered Thinking | |
The National Learning Community Curriculum
Location: The Royal Conference Center, 3801 Hillsborough St, Raleigh
Date: April 1-2, 2014
Service definitions continue to require providers to participate in 12-hour training programs on Person Centered Thinking. The 12-hour training approved by the National Learning Community for Person Centered Practice must be provided by an approved trainer. This training meets those requirements and much more.
Cost: Benchmarks Members $108.00 (for both days)
Non Members $120.00 (for both days)
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| Training - System of Care Child & Family Teams | | Date: March 27-28
Cost of Training: Service Providers $35; Family Members - FREE!
Trainings are from 9:00 to 4:00
For questions, call Lisa Allen, Training Coordinator 828-586-5501 Ext. 1163 |
| NC Innovations Training Series |
Smoky Mountain Center is pleased to offer the first in a series of training on the NC Innovations Waiver for Individuals with Intellectual/Developmental Disabilities. The NC Innovations Waiver is designed to provide an array of community based services and supports to promote choice, control and community membership. This training will provide an overview of the role and responsibilities of agencies providing NC Innovations services. Topics will include:
- Goals of the Waiver
- Quality of Care
- Documentation
- Health and Safety
- Freedom of Choice
- Relative as Provider
Targeted Audience: Qualified Professionals, Agency Directors, and others interested in learning more about NC Innovations.
Trainer: Jesse Smathers, B.S.Ed., NC Innovations Technical Director, Smoky Mountain Center. Jesse has over 15 years experience in the administration of Home and Community based waivers for individuals with intellectual and developmental disabilities. He is currently pursuing a Master's Degree in Social Work with a generalist focus and a concentration in addiction studies.
Schedule and Locations: Questions - Call Lisa Allen, Training Coordinator 828-586-5501 Ext 1163
Training Date: Monday, March 31, 2014
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| Wellness Recovery Action Plan® (WRAP®) classes | | Smoky Mountain Center is hosting the following Wellness Recovery Action Plan® (WRAP®) classes for consumers and families. Please share this information in your community.
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| Expand Your Toolbox | |
Expand Your Toolbox
...a series for Parents, Teachers and Support Staff providing intensive training experience for parents and teachers who want to increase their knowledge and acquire specific intervention skills to maximize success of their children with behavioral challenges, social interactions, sensory issues and speech delays.
April 11, 2014 9:00 - 11:0
Engaging the Spectrum, FIRST P.L.A.Y. project
May 9, 2014 9:00 - 3:30
Strategies for Disrupting Behavior & Social Skills
All sessions presented by experts in their field. |
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Smoky Mountain Center's Access Call Center is available 24 hours a day, 7 days a week to provide information, screening, triage and referrals for mental health, substance abuse and intellectual/developmental disability services. The toll-free phone number is 1-800-849-6127. |
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