General inquiries: 828-225-2784
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: 828-225-2784, ext. 1500, 8:30 a.m. to 5 p.m. M-F
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2015 Provider Summit
This is the last week to register. The agenda keeps getting better!
Attend to win! Complete the Provider Advisory Council Survey during the afternoon session to be entered to win one of four great prizes:
- Joint newspaper ad with Smoky (value up to $500, only one winner per provider agency)
- Joint newspaper ad with Smoky (value up to $300, only one winner per provider agency)
Date: Monday, September 21, 2015
31 Woodfin Street
Asheville, NC 28801
For information regarding parking please visit the registration page by clicking the button above.
Agenda:
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9:00 - 10:00 a.m.
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Check-in (coffee and pastries served)
| 10:00 - 10:10 a.m.
| Welcome and introductions
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10:10 a.m. - 12:00 p.m.
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Medicaid Reform: What Will it Mean to You?
A panel discussion moderated by Lanier Cansler, President of Cansler Collaborative Resources
Panelists:
- Dave Richard, Deputy Secretary of Medical Assistance, Department of Health and Human Services
- Karen McLeod, President and CEO, Benchmarks
- Dr. Jeff Heck, President and CEO, Mountain Area Health Education Center
- Marc Malloy, Senior Vice President of Health Plan Solutions, Mission Health
- Brian Ingraham, CEO, Smoky Mountain LME/MCO
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12:00 - 12:15 p.m.
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Morning wrap-up
| | 12:15 - 1:45 p.m. | Lunch (on your own) | | 1:45 - 1:50 p.m. | Afternoon kick-off | |
1:50 - 2:10 p.m.
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| | 2:10 - 2:20 p.m. | Network Development Plan | | 2:20 - 2:35 p.m. | Provider Operations Manual | | 2:35 - 2:50 p.m. | Break | | 2:50 - 3:20 p.m. | Provider Advisory Council survey | | 3:20 - 3:40 p.m. | Clinical Operations | | 3:40 - 4:10 p.m. | Whole-Person Care | | 4:10 - 4:30 p.m. | Closing comments and prize drawing (You must be present to win) |
If you have questions, or need assistance with registration, please email Tommy Duncan.
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Care Management update
(b)(3) Support employment update and correction
The August Communication Bulletin regarding (b)(3) service updates stated that (b)(3) Supported Employment would require "No prior authorization for first 64 units for initial engagement". AlphaMCS is unable to allow "pass-through", therefore, service for first 64 units must be submitted via a Service Authorization Request (SAR). We apologize for any confusion.
Person-Centered Plan (PCP) quality of care review
Care Management continues to expand its quality of care reviews to include PCPs.
Effective October 15, 2015, initial SARs that include PCPs will be reviewed for the following items:
- Measurable goals and identified frequency and intensity of interventions
- Individualization that meets the consumer's needs
- Inclusion of goals related to increased functioning, independence, and quality of life
- Active consumer engagement in plan development
- Medical co-morbidities
- Intellectual/developmental co-morbidities
- Goals that include psychotropic medication monitoring
Care Management reminders
Care managers use CALOCUS, LOCUS and ASAM scores to determine appropriate levels of care for mental health and substance use disorders. For individuals dually diagnosed with a mental health and substance use disorder, Smoky requires SARs that include both CALOCUS/LOCUS and ASAM scores, regardless of requested treatments. SARs submitted without these scores will be administratively denied.
Smoky care managers approve or deny service requests within 14 days after receiving a SAR. All routine requests should be submitted to Smoky at least 14 days prior to the effective start date of the service. Providers must submit requests for continued service authorizations at least 14 days prior to the end of the current authorization. These deadlines ensure care management decisions are made before current authorization ends, giving providers and consumers sufficient notification to avoid lapses in covered days.
Paper SARS
For Innovations providers: When a paper SAR is required until a SAR can be entered into the AlphaMCS system, please bill for services. Even though it will result in a claim denial, it will prevent timely filing denials once a SAR can be processed in the AlphaMCS system.
Document naming conventions
When saving and uploading documents to AlphaMCS, please use the following naming conventions:
1) Use sufficient identifiers in the structure for easy recognition and retrieval.
Example: Tng_SkilSoft_QTR1_2014_01_11
2) When including a date, use the year first followed by the month and day to sort dates chronologically in document retrievals. Dates should be ordered: YEAR, MONTH, DAY. (e.g. YYYYMMDD, YYYYMMDD, YYYYMMDD). Time should be ordered: HOUR, MINUTES, SECONDS (HHMMSS)
3) Use the underscore (_) as opposed to spaces or other characters
Example: PGS_NOTES_IHSB_ 2015_01_02
4) Personal names within an element should have a surname listed first, followed by first names or initials.
Vocational Rehabilitation and Supported Employment
The Supported Employment (SE) service definition exclusions section states, "SE may not be provided if the service is otherwise available under a program funded under the Rehabilitation Act of 1973, P.L. 94-142, or under the Individuals with Disabilities Education Act, 20 U.S.C. 1401 et seq. For individuals with SMI per the IPS model, an individual may be open with the Division of Vocational Rehabilitation (VR) at the same time he or she is open with an SE provider. At no time should a provider bill both VR and the LME/MCO at the same time for the same person. Medicaid is always the payer of last resort."
When a person requests Supported Employment, the documentation should include information about Vocational Rehabilitation (VR) services (whether or not the person has worked with VR; if the person has not worked with VR, has the person been offered the choice to work with VR; and if VR is not appropriate, a description of why). |
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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. unencrypt |
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Smoky Mountain LME/MCO | 200 Ridgefield Court, Suite 206 | Asheville, NC 28806
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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.
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