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Welcome to Smoky's new Provider Network Bulletin!
To better serve you, Smoky is introducing a redesigned, streamlined Provider Network Bulletin. You will receive this bulletin the first week of every month. Occasionally, you may also receive provider alerts regarding urgent matters. This April, we are also launching a new monthly Claims Corner Bulletin, published the third week of the month.
These bulletins include essential information you need to know to do business as a provider in the Smoky network. Please read them carefully. If you have questions or suggestions for improving communication with you, please email us at provider.communication@smokymountaincenter.com.
Smoky manages public funds for mental health, substance use and intellectual or developmental disability services in 23 counties in western North Carolina. Thank you for the important work you do for the people we mutually serve. |
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Smoky general information
All Smoky departments and staff can be reached at 828-586-5501
Administrative headquarters
Smoky Mountain LME/MCO
200 Ridgefield Court, Suite 206
Asheville, NC 28806
Provider questions
Call 1-866-990-9712, send an email to
or contact your account specialist
Confidential Compliance Hotline
(To report fraud or abuse): Report online or call 1-866-916-4255, 24 hours a day
AlphaMCS technical support
Call 828-586-5501, ext. 1500, 8:30 a.m. to 5 p.m. Monday through Friday
Incident reporting
More information
Visit the Smoky website for more about:
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Smoky's Provider Advisory Council is representative of different types of providers practicing throughout our 23-county catchment area. Find out more about the advisory council, view council meeting minutes and get information about upcoming events on the council's page on the Smoky website. |
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UPCOMING TRAININGS & EVENTS |
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Motivational Interviewing
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Reminder: New requirements for Service Authorization Requests
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At Smoky, care managers use CALOCUS, LOCUS and ASAM scores to determine appropriate levels of care for mental health and substance use disorders. Effective May 1, 2015, Smoky will require that Service Authorization Requests (SARs) be submitted for individuals dually diagnosed with a mental health and substance use disorder that includes both a CALOCUS/LOCUS and an ASAM score, regardless of the requested treatment. Smoky will administratively deny SARs for these individuals that lack both scores.
Smoky care managers make decisions to approve or deny service requests within 14 days after receiving a SAR. The request should be received at least 14 days prior to the effective start date of the service for all routine requests. Providers must submit requests for continued service authorizations at least 14 days prior to the end of the current authorization. This ensures care management decisions are made before the end of the current authorization and allows for providers and consumers to be notified of the decision and avoid lapses in covered days.
For information about CALOCUS/LOCUS and other trainings, visit the Smoky website and click on the Calendar of Events. The next training sessions are scheduled for April 14, 2015, at the WCU Campus at Biltmore Park, Room 338 in Asheville.
LOCUS training is scheduled for 9 a.m. to 12 p.m. REGISTER ONLINE
CALOCUS training will be from 1 to 4 p.m. REGISTER ONLINE
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Smoky introduces new template for Comprehensive Clinical Assessments
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Smoky has developed a Comprehensive Clinical Assessment (CCA) template to improve assessment consistency and quality. This recommended template contains key elements required by Clinical Coverage Policy 8C. Providers may access this template on the provider section of the Smoky website.
Smoky care managers review CCAs when making clinical decisions. We encourage providers to use this template to ensure they provide Smoky all necessary psychosocial and clinical information to assess medical necessity and quality of care.
Smoky encourages providers to complete optional sections of this template (shaded in blue) that address integrated care. These sections are not required by Clinical Coverage Policy but are helpful in promoting whole-person care.
A CCA is an intensive clinical and functional face-to-face evaluation of an individual's mental health, intellectual or developmental disability or substance use disorder and provides the clinical basis for the development of a treatment or service plan. The CCA written report must be included in the service record. The CCA demonstrating medical necessity must be completed by a licensed professional prior to provision of outpatient therapy services. A CCA does not have a designated format, but the assessment, or collective assessments, must include all elements indicated in Clinical Coverage Policy 8C, including:
 A description of presenting problems, including the source of distress, precipitating events and associated problems or symptoms- A chronological general and behavioral health history (including mental health and substance use) of an individual's symptoms, treatment and treatment response
- Current medications (for both physical and psychiatric treatment)
- A review of biological, psychological, familial, social, developmental and environmental dimensions to identify strengths and risks
- Evidence of an individual's and, if applicable, the individual's legally responsible person's participation in the assessment
- Analysis and interpretation of assessment information with an appropriate case formulation
- Diagnoses from the DSM-5 or subsequent editions, including mental health, substance use disorders and/or intellectual or developmental disabilities, as well as physical health conditions and functional impairment
- Recommendations for additional assessments, services, supports or treatment based on the CCA
Please direct any questions to the Care Management Department at 1-800-893-6246, ext. 1513. |
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Quality and Integrity Operations: Helpful tips for providers
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When completing an incident report, please answer six critical questions in your narrative: who, what, when, where, why and how.
Investigations are about more than just documentation. Smoky takes an in-depth look into incidents to determine what, if any, steps are needed to protect consumers and prevent further acts of abuse, neglect, misappropriation of property, drug diversion or fraud.
Healthcare Personnel Registry
Healthcare Personnel Registry (HCPR) requires an initial report within 24 hours and a final investigative report within five business days. Providers should submit incidents directly into IRIS to meet the 24-hour deadline. The report is then sent directly to HCPR for investigation. LME/MCOs will not have access to these incident reports for incidents not related to a consumer.
Providers must submit incidents related to consumers to HCPR through IRIS. Both the 24-hour and the five-day report must be completed. Providers should complete reports in IRIS, as Smoky does not know what is submitted directly to HCPR.
For information on how to report an allegation, call the HCPR Investigation Branch at 919-855-3968 between the hours of 8 a.m. to 5 p.m. or visit the HCPR website.
IRIS
All incidents should be submitted within 72 hours of "provider learned" date. Our goal is 93 percent provider submission compliance. For January and February, we had 76 percent, a 10 percent increase since December. Thank you, and please help us by continuing your timely submissions.
Back-up Staffing (BUS)
Currently, 610 incidents are in "saved" or "hand over to provider" status in AlphaMCS. We are unable to process these incidents. "Saved" reports are those that were begun and saved by the provider (by clicking "save") but not submitted (by clicking "submit"). Reports needing additional information are classified as "hand over to provider." Both types of reports need to be completed and submitted.
To determine if you own one of these incidents, please follow these steps:
- Filter
- Status - hand over to provider /or/ saved
- Search
Please be aware that only the person who entered the incident may correct it.
Incident report training
The training program for IRIS and BUS is close to approval. We expect to start scheduling trainings in August. For more information, send an email to incidentreport@smokymountaincenter.com with the subject line "Training." Also let us know if you have questions, concerns or topics you would like discussed in the training.
Questions, concerns and technical assistance
For assistance, contact a member of the Incident Report Team:
Ayofemi Powell: 828-586-5501, ext. 1104
Ayofemi.powell@smokymountaincenter.com
Tashia Shamwell: 828-586-5501, ext. 5094
Tashia.shamwell@smokymountaincenter.com
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ICD-10 implementation:
Initial provider communication
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Smoky is providing a series of communications to update providers about our readiness for ICD-10 implementation and help guide provider compliance.
ICD-10 implementation will occur during the next six months, with an implementation date of October 1, 2015. Are you prepared for the conversion from ICD-9 to ICD-10?
ICD-10 is the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and revises the ICD-9-CM system used by healthcare providers to classify and code diagnoses, symptoms and procedures recorded in conjunction with hospital care. ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just providers who submit Medicare or Medicaid claims. Healthcare providers, payers, clearinghouses and billing services must be prepared to comply with the ICD-10 transition. This change does not affect CPT coding for outpatient procedures.
What are the main differences between the coding systems?
ICD-10 will offer a greater degree of specific information in areas such as right versus left, initial or subsequent encounter and other relevant information, and will expand the number and length of codes.
Number of codes:
To provide more information, ICD-10 will have roughly 68,000 available codes (with flexibility to add more) compared to ICD-9's 13,000 codes and limited space for additions. Codes may be different than before, so coders need to understand how to effectively search for codes under the new system.
Length of codes:
ICD-10 uses codes that may be longer, following a basic structure. If necessary, digit 7 will serve as an extension and be either alphabetic or numeric.
The transition to ICD-10 will require advanced planning and preparation. Smoky will not be able to approve or pay for claims from providers who are not able to submit claims and transactions into the Smoky-compliant system. Please be prepared for this transition.
Smoky has established a cross-functional workgroup to guide Smoky's implementation of ICD-10. Duties include assuring the readiness of AlphaMCS and Smoky systems, educating staff and supporting provider engagement and adoption. Providers are responsible for training their staff, managing and assuring ICD-10 compliance.
Smoky has developed an ICD-10 implementation project plan that features systems testing, staff training and regular communications and feedback. Visit the Claims and Eligibility and Enrollment page on the Smoky website for project details, timeframes and opportunities for providers. Scroll down the page for additional information in the ICD-10 Resources and Implementation bar.
We expect that providers will have access to a testing environment by May 15, for a period of 120 days. This information will be shared as it becomes available. |
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Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual and developmental disabilities in the North Carolina counties of Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey.
For immediate help in a crisis, information about services, screenings and treatment referrals, call 1-800-849-6127, 24 hours a day,
seven days a week (TTY: Call Relay NC 711). Visit us online at www.smokymountaincenter.com.
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