Sites and Services Menu  

Smoky will begin sending out FY15-16 Medicaid and State contracts to Network Providers who have been selected for renewal the first week of June. We wanted you to be aware of an important change in the contract template that was made to reduce administrative costs and improve efficiencies for both you and Smoky: we are removing the Sites and Services Menu ("Menu") that was previously included in the contract as Attachment A. Instead, the contract will include a reference to the sites and services associated with your agency in AlphaMCS. A copy of the Menu will still be provided to you with your contract or whenever a change is made to the Menu. This change streamlines the process of updating your profile in AlphaMCS and eliminates the need for a contract amendment every time a change is made to sites, services or billing codes. Under this new process, if a change is approved, it will be entered into AlphaMCS and automatically incorporated into your contract, enabling you to bill for services much sooner. Contract amendments will no longer be required prior to these changes taking effect. However, any name changes will still require a contract amendment. Please remember that it is your responsibility to be aware of the sites, services and billing codes that are approved for you or your agency to bill Smoky. To notify Smoky of an error in the Menu, request a change related to sites or services, or for more information about this topic, please contact Provider Network at the contacts listed below.

Quick reference:

Provider Relations Line: 1-866-990-9712

Provider Relations Email: providerinfo@smokymountaincenter.com

Site-Specific NPIs

Smoky has encountered numerous denials in its "upstream" billing of claims to DHHS when a provider's service site on the claim does not match that in NC Tracks. This primarily occurs where a provider serves consumers at several sites but only has one NPI for multiple sites. Denials in upstream billing put Smoky's revenue stream at risk and require time-consuming work by both Network Providers and Smoky to correct the issue. Accordingly, Smoky has made the decision to require all Network Providers to obtain a National Provider Identifier ("NPI") for each billable site at which it provides services to Smoky consumers. This policy will take effect October 1, 2015, and will be included in FY15-16 provider contracts. On or before that date, all Network Providers must obtain site-specific NPIs and comply with taxonomy requirements regarding service and specialty licensure. More information regarding taxonomy specifics will be released in July.

Smoky's research indicates that there are no costs associated with obtaining an additional NPI. The fee for initial enrollment and re-verification only applies to each EIN (a/k/a tax ID) of a provider, regardless of the number of NPIs associated with each EIN. Accordingly, a Network Provider should not incur additional costs to comply with this change, as Smoky is not requiring additional EINs. Aside from streamlining the claims process, site-specific NPIs would further benefit providers and Smoky by allowing for simpler electronic transmission of HIPAA standard transactions; more efficient coordination of benefits activities; more effective utilization review activities; better insulation from potential cross-indexing; and would offer enhanced tracking for medical records' needs, group practice productivity measures and revenue collection efforts. If you have any questions or need additional information about this decision, please contact Provider Network directly at the contacts listed below.

Quick reference:

Provider Relations Line: 1-866-990-9712

Provider Relations Email: providerinfo@smokymountaincenter.com

Notice to Users of Clearinghouse Emdeon

Emdeon is a clearinghouse used by providers and other clearinghouses to submit Electronic Data Interchange (EDI) files containing bulk claim transactions, including response files (837I, 837P, 835, 999, etc.) to Smoky for processing and payment of provider claims. Smoky's contract with Emdeon expires on July 13, 2015, and Smoky will not renew this contract after its expiration because of the fees charged to Smoky by Emdeon. We believe that Smoky is entitled to an exemption of the fee as a government entity, but Emdeon has not approved the fee waiver. This means that Smoky will no longer utilize Emdeon's services after July 13, 2015. To facilitate the closeout of your claims processing through Emdeon, we ask that you adhere to the following timeframe:

• If remittance of your claims does not flow back to you through Emdeon, please submit claims no later than the close of business on July 12, 2015.
• If remittance of your claims does flow back to you through Emdeon, please submit your claims no later than the close of business on June 26, 2015. 

Smoky provides two methods of submission for providers and other clearinghouses: (1) direct submission to Smoky; and (2) indirect submission via a participating clearinghouse. Going forward, Smoky will continue to accept claims from participating clearinghouses who meet certification requirements. Any provider or clearinghouse not currently submitting EDI files to Smoky and who wish to submit claims directly to Smoky must be certified to do so. The certification process will require execution of a Trading Partner Agreement, and the submitter must successfully pass format and content testing with Smoky. In order to prevent any disruption in your claim submissions and/or payment, it is imperative you contact Smoky's EDI representative to begin the certification process. You can initiate the process by sending an email to edi@smokymountaincenter.com.

If you are unsure whether this affects your organization, please forward this communication to the person(s) responsible for your billing. If you have any questions or need additional information about this decision, please contact Provider Network directly at the contacts listed below.

Quick reference:

Provider Relations Line: 1-866-990-9712

Provider Relations Email: providerinfo@smokymountaincenter.com

AlphaMCS User Agreement

Smoky is committed to ensuring the privacy and security of sensitive information we maintain, including protected health information. In order to further improve our security efforts, Smoky will be implementing a new AlphaMCS User Agreement with the FY15-16 contract cycle. This agreement will formalize the responsibilities that AlphaMCS users agree to when they complete training and are assigned a login and password. The AlphaMCS system requires a secure login for each individual system user. Sharing logins is not allowed. As part of this effort, Smoky will be completing a review of all AlphaMCS users associated with each agency. Moving forward, Smoky will regularly send providers a list of users and will require providers to verify the accuracy of the user list. The agreement will require providers to identify a security contact at their agency and notify Smoky when staff who have been assigned an AlphaMCS login leave employment so that Smoky can accurately track and disable logins when necessary. Again, these measures are designed to improve our security efforts and further protect the sensitive information we maintain. If you have any questions or need additional information about AlphaMCS or the proposed user agreement, please contact the Management Information Systems (MIS) department directly at the contacts listed below.

Quick reference:

MIS HelpDesk: 1-828-586-5501, ext. 1500

MIS Email: helpdesk@smokymountaincenter.com