Smoky's Provider Advisory Council is representative of different types of providers practicing throughout our 23-county catchment area. To find out more, view Council meeting minutes and get information about upcoming events, go to the Council's page on the Smoky website.
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UPCOMING TRAININGS AND EVENTS
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Heart Based Therapeutics™ Program
Transforming the quality of
Whole-person Care
Heart Based Therapeutics™ trainings for healthcare and human services professionals, jointly provided by MAHEC and Heart Based Institute.
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Welcome to the Smoky Mountain MCO Provider Network Bulletin. This monthly bulletin features news you need to know as a provider in the Smoky network and information you need to do business with Smoky.
Smoky manages public funds for mental health, substance use and intellectual or developmental disability services in 23 counties in western North Carolina. It is our pleasure to work with you to serve the needs of our local residents. |
Operations at a Glance
A monthly overview of Smoky operations
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Smoky Provider Advisory Council
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Smoky's Provider Advisory Council (PAC) and Regional Provider Councils (RPCs) represent providers from the 23 counties of our catchment area. The councils provide input, feedback and guidance to Smoky from the service provider's perspective. Our PAC and RPCs are composed of voting members and participants from provider agencies, our Consumer and Family Advisory Committee (CFAC), hospital systems and Community Care of North Carolina (CCNC), as well as licensed independent practitioners and Smoky representatives.
All providers are welcome to attend council meetings, which are held the third Wednesday of every month from 10:00 a.m. to 12:30 p.m. at the Crowne Plaza Resort in Asheville.
Four Regional Provider Councils meet quarterly:
| Northern Region | Alleghany, Ashe, Avery, Watauga and Wilkes | | Central Region | Alexander, Caldwell and McDowell | | Western Region | Cherokee, Clay, Graham, Haywood, Jackson, Macon and Swain | | Highlands Region | Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey |
All information and communications related to the PAC, RPCS and PAC subcommittees can be found on our MyCommittee.com page. Voting members and attendees can access information about council meeting times and locations, agendas, meeting minutes, voting members, officers, by-laws and other council-related business. Visitors to the site can also access information on upcoming meetings, by-laws and minutes from the past PAC meetings dating back six months.
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Smoky general information
All Smoky departments and staff can be reached at 828-586-5501.
Administrative headquarters
Smoky Mountain 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 suspected 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
Call 828-586-5501, ext. 5094 or 1104.
More information
Visit the Smoky website for more about:
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Visit these sites for additional training opportunities:
Click here to view the NC Council of Community Programs calendar
Click here to view the MAHEC calendar
Click here to view the Northwest AHEC calendar |
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Attention Innovations Waiver providers
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 Proposed Medicaid Waiver Clinical Coverage Policy 8-P has been posted for review and public comment.
The deadline for comments is September 18, 2016.
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Direct enrollment for therapeutic foster care and day treatment providers
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A recent communication bulletin issued by the North Carolina Divisions of Medical Assistance and Mental Health, Developmental Disabilities and Substance Abuse Services notified LME-MCOs and providers about direct enrollment in NCTracks for reimbursement of therapeutic foster care (TFC) and day treatment services provided to the following populations:
- Medicaid beneficiaries ages 0 to 3
- Legal aliens
- All North Carolina Health Choice beneficiaries
To be reimbursed for TFC and day treatment services provided to the populations listed above, providers must be actively enrolled with NCTracks by October 1, 2016. After October 1, pass-through billing via LME-MCOs will not be allowed.
Visit the North Carolina Department of Health and Human Services website to read the bulletin in its entirety.
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Changes to SAIOP and SACOT authorization guidelines
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Effective August 1, 2016, authorization is not required for Medicaid or state-funded Substance Abuse Intensive Outpatient Treatment (SAIOP) or Substance Abuse Comprehensive Outpatient Treatment (SACOT) services. This update applies to the initial "pass-through" service period and the continued services following pass-through that complete an episode of care.
Please note that all documentation required by Clinical Coverage Policy 8A, State-funded Enhanced Service Definitions and other applicable records and documentation requirements still apply. Providers should continue to maintain such documentation in service records, regardless of prior authorization requirements.
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Authorization for outpatient therapy services
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Although outpatient therapy services do not require authorization under Smoky's Medicaid benefit plan, there are circumstances under which a service authorization request (SAR) should be submitted.
Providers of outpatient therapy services must ensure all services provided are medically necessary and delivered as defined in Clinical Coverage Policy. Many Medicaid-funded enhanced and residential services as defined in Clinical Coverage Policy have service exclusions prohibiting concurrent outpatient therapy or other periodic services (Assertive Community Treatment Team or Intensive In Home, for example). In exceptional cases--typically when the member's needs include some type of specialized intervention--it may be necessary for a member to receive outpatient therapy services in addition to an enhanced or residential service. Outpatient providers who determine an exceptional need exists should request authorization for the outpatient therapy delivered concurrently with another prohibited service. Smoky's care management team will evaluate medical necessity and issue an authorization accordingly.
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Save the date: DMA professional stakeholder meeting on August 19
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| WHAT: | Stakeholder Meeting | | WHEN: | Friday, August 19 from 1:00 to 3:00 p.m. | | WHERE: | Dorothea Dix Hospital, Dix Grill Employee Center |
The Division of Medical Assistance, Clinical Policy, requests your participation as a professional stakeholder in reviewing a requirement for nurse practitioner training in N.C. Medicaid Clinical Coverage Policy 8C, Outpatient Behavioral Health Services Provided by Direct Enrolled Providers. The policy currently includes a clause requiring all nurse practitioners delivering behavioral health services to have certification as Psychiatric Mental Health Nurse Practitioners by July 2017.
Please note, this is an in-person meeting only; a call in number will not be available. Seating is limited. Please RSVP by Monday, August 15 to Kelsi Knick (kelsi.knick@dhhs.nc.gov).
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Innovations Crisis Services
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All Innovations Waiver contracted providers of Residential Supports, In-home Skill Building, Personal Care, and/or In-home Intensive Supports are required to have the capacity to offer Innovations Crisis Services for emergencies that occur with participants in their care 24 hours per day 7 days per week or have a Memorandum of Agreement with an in-network provider of Primary Crisis Services. With the Innovations Waiver amendment effective November 1, 2016, Community Living & Supports and Supported Living will be included with the above listed services.
Providers are expected to respond to emergencies/crisis on weekends and evenings as outlined in the Innovations service definitions. Crisis can occur in the form of mental health/behavioral or medical needs.
Smoky expects providers to:
- Train members and their paid/unpaid supports in how to access the provider crisis responder;
- Understand how to access Crisis Response services and implement them to fit the nature of the crisis;
- Be knowledgeable of their role in a crisis for that consumer, including Mobile Crisis Management.
Providers are expected, at a minimum, to assess by phone to determine if a face to face is needed, and the assessment should determine if implementation of Crisis Response Services is necessary.
Crisis Services is an immediate intervention available 24 hours per day, 7 days per week to support the person who is primarily responsible for the care of the beneficiary. Crisis Services is provided as an alternative to institutional placement or psychiatric hospitalization.
For more information please contact your Provider Network Specialist.
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Smoky Mountain 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.
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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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