General inquiries: 828-586-5501
Provider questions: Call 1-866-990-9712, contact your account specialist or email
Confidential Compliance Hotline for suspected fraud and abuse: Report online or call 1-866-916-4255
AlphaMCS technical support: 828-586-5501, ext. 1500, 8:30 a.m. to 5 p.m. M-F
|
|
|
|
Restoration of diagnosis codes and groupings to Smoky Benefit Plans
Changes made to the AlphaMCS configuration initially end-dated multiple diagnosis codes effective February 26, 2015. As a result, provider claims with these diagnoses were denied with a reason code of "Invalid diagnosis" or "Invalid PC (procedure code)/Dx Combo (diagnosis combo)." To resolve this issue, Smoky has added diagnoses back into diagnosis group mappings in the AlphaMCS system. The updates went into effect June 3, 2015, with coverage fully extended to the initial February 26 end date.
The following diagnosis codes have been added back into the State and Medicaid Benefit Plans:
The following diagnosis codes and diagnosis grouping combinations have been added:
- 299.00 has been added to Mental Health (MH) group for State, Medicaid B and Medicaid C
- 294.11 has been added to Intellectual and Developmental Disabilities (IDD) group for State and Medicaid B
- 294.10 has been added to IDD group for State, Medicaid B and Medicaid C
- 293.81 has been added to MH group for State, Medicaid B and Medicaid C
Smoky has taken steps to readjudicate and reprocess all claims filed that may have denied due to these lapsed diagnoses. Providers should see readjudication results reflected on Remittance Advices (RA's) dated June 3, June 10, and June 17, 2015. Please note, reprocessing is not an assurance of claims adjudicating fully and paying, as a claim may encounter other system edits independent of the diagnosis that may cause the claim to deny.
Please contact your claims specialist with any questions.
|
ICD-10 Training 
Register for an upcoming training to prepare for the transition to ICD-10.
ICD-10 codes are longer and more complicated than ICD-9 codes. The crosswalk of the
ICD-9 code set to ICD-10 is also more complex.
This training will prepare staff responsible for diagnosing, coding or submitting claims. Specialized sessions are available for both clinical staff and financial and claims staff.
|
|
About provider email alerts
You are receiving this alert because you are a member of the Smoky provider network or have signed up for our Provider Network Bulletin. Smoky issues email alerts to convey critical information as soon as possible. Please note that if you unsubscribe from these alerts, you will also be removed from the Provider Network Bulletin mailing list and may miss out on important information. |
|
|
Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual/developmental disabilities in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey counties in North Carolina. For immediate help or information about services, call 1-800-849-6127, 24 hours a day (TTY: Relay NC 711). Visit us at www.smokymountaincenter.com.
|
|
|
|
|
