VOL. 1, ISSUE 2 | MAY 2015
 
Greetings from Smoky Mountain's Claims Department!

Welcome to the Claims Corner and Eligibility & Enrollment (E&E) Edge from Smoky Mountain LME/MCO. We hope you'll find this monthly bulletin helpful in answering questions about claims and eligibility and enrollment processes. It is our honor to do business with you. For more information, see our Provider Network Bulletin. 

 

 

 SMOKY OPERATIONS AT A GLANCE

 April 2015 data
NEED ASSISTANCE?
  For claims-related questions, email 
 or call 828-225-2785, ext. 2455.

  

For enrollment and eligibility questions, email EandE@smokymountaincenter.com

or call 828-225-2785, ext. 2355.

  
       
QUICK LINKS
                        
denialDENIAL SPOTLIGHT - 35: Service is not authorized 
 
 
Background
The service performed was not authorized.
 
What causes this denial?
AlphaMCS references provider contracts in determining authorization requirements for procedures. Claims are denied when authorization is required for the procedure code for the service facility and the authorization code is not in the database. Claims are also denied if the service facility site on the claim does not match the site designated on the authorization.

 

How do I correct the denial? You should verify the service authorization for the consumer listed and verify that the site on the claim matches the site (service facility location) on the authorization.

 

Tips on service facility location

If you are billing through the AlphaMCS portal, all claims default to the provider's main site. The correct site must be selected in the dropdown box. If you are billing through the 837 electronic file, use the service facility NPI and corresponding ZIP+4 for the correct site.

 

For questions about or changes to authorizations, contact Smoky's Clinical Operations Department at 828-225-2785, ext. 1513 (MH/SU), or ext. 1902 (I/DD). You may also email us at um@smokymountaincenter.com.

 
alphamcs
AlphaMCS technical assistance and improvements

 

For AlphaMCS technical assistance, contact our HelpDesk at 828-225-2785, ext. 1500, or at helpdesk@smokymountaincenter.com.
 
Providers can submit enhancement requests for the AlphaMCS Provider Portal to AlphaCM. A provider-led AlphaMCS users group meets on the fourth Monday of the month at 1:00 p.m. Providers can discuss AlphaMCS and potential enhancements to improve functionality. Call 
1-877-885-3221, meeting passcode 6178667.
 
credentialing
Credentialing questions and
status updates

Please direct all credentialing and status update questions to credentialing in the Provider Network Department. The Claims Department no longer takes questions about credentialing. The Claims Department can help with potential claims issues due to outstanding credentialing time frames once credentialing issues are resolved.

 

You can learn about credentialing on Smoky's website. Providers may contact Smoky credentialing staff at

1-855-432-9139 or send an email to credentialingteam@smokymountaincenter.com.  

 

icd10ICD-10 implementation: Information to know about ICD-10 testing

 

This month, we bring you the second in a series of communications on our readiness and your compliance as a provider for ICD-10 implementation.

 

Full implementation of ICD-10 will occur over the next six months, with an implementation date of October 1, 2015. Smoky has started testing ICD-10 in the NCTracks system, and the results will help us improve the AlphaMCS system. We expect to have a testing environment beginning this month for select providers to submit test claims and files.

 

We are seeking providers interested in being part of our system testing. Testing will occur in a staging environment within the AlphaMCS module. Providers are not required to participate in testing. Smoky will select a representative testing sample from the pool of self-identified providers.

 

If your organization is interested in participating, send an email request to ICD10@smokymountaincenter.com. Use "Interest in Testing" as the subject line and include the following information in the body:

 

  • Provider name
  • AlphaMCS ID
  • Claims system and/or clearinghouse
  • Contact information (name, phone, email address) for the person representing your organization

 

For ICD-10 resources and education, visit our Claims and Eligibility and Enrollment website.

 

bulletinremindersBulletin reminders 

 

Learn information you need to know on the N.C. Department of Health and Human Services website.

  

Behavioral health unmanaged visits

Visits to restart on state fiscal versus calendar year

 

Associate-level licensed providers

Direct enrollment

  

PRTF claims

Changes for psychiatric residential treatment facility (PRTF) services claims

 ____________________

 

nctracksNCTracks

 

To sign up for NCTracks provider communications, visit the NCTracks website. Click "Sign up For NCTracks Communications" in the top right corner.

  

  
claimsmanualNew Smoky Claims Manual and Billing Guide in development for coming fiscal year
 
Smoky is proud to announce its Claims Manual and Billing Guide. This new guide take will take effect in the 2015-16 fiscal year contract cycle and provide information and support for processing claims through Smoky.
 
Topics covered include:
  • Provider responsibilities
  • Smoky responsibilities
  • Claims, eligibility and enrollment processes
  • General assistance and troubleshooting

The electronic guide features a user-friendly clickable table of contents, an index and a glossary. Reference boxes highlight important resources and notes call attention to items of interest.

 

The Claims Manual and Billing Guide is a legal document designed to answer practical questions, clarify processes and connect you with appropriate staff for assistance.

 

After the comment period closes, the document will be finalized and take effect July 1, 2015. The finalized language will be a part of your new fiscal year contract. The final document will not be available for review until June 1, 2015.

 

Please have appropriate staff review this manual. Providers are required to understand the contents of this legal document.

CPTcodes2015 Current Procedural Terminology Code update for May

  
Smoky has incorporated new 2015 Current Procedural Terminology (CPT) codes for which  rates have been made available. Smoky claims staff has reprocessed these claims, which previously denied for "No rate available". Providers should see these payments reflected on Remittance Advice (RA) beginning May 5. We expect to have confirmation from the N.C. Division of Medical Assistance of the rates for remaining codes in pending status by the end of May.

 

This is an excerpt from the update, "CPT Code Update: 2015", in the January 2015 Medicaid Bulletin. All 2015 CPT codes should be uploaded into NCTracks by the end of May. Codes not fully installed into NCTracks will be manually entered into the system. Claims submitted with some 2015 CPT codes will continue to pend in NCTracks for "Rate not found".

 

An announcement will be posted when remaining 2015 CPT codes are updated in NCTracks.
 
  

residentialtxAttention residential treatment providers: Modified billing codes

 

The following Smoky benefit plan codes and contract details have changed. Existing codes for Level III and Level IV (4 beds, and 5+ beds) will be end-dated May 2. New codes went into effect May 3, 2015. Providers are required to make these changes regarding transactions:

 

Claims: For dates of service up to May 2, providers should file claims using the old codes. For claims beginning May 3, providers should file using the new codes.

 

Authorizations: For current or prior approved residential treatment authorizations, Smoky will end-date existing authorizations and enter new authorizations for remaining units of service with these modified codes through the end of the existing authorization. Providers must use the new codes for any new Service Authorization Request (SAR) effective May 3 or thereafter. A provider whose authorization request has dates both prior to and after May 3, 2015 should submit two separate authorizations.

 

For authorization information, email um@smokymountaincenter.com or call 828-225-2785, ext. 1902. For claims issues, email claims@smokymountaincenter.com or call 828-225-2785, ext. 2455. 
icdcrosswalkICD 9/10 crosswalk: Online code look-up from N.C. DHHS

The latest version of the ICD 9/10 crosswalk is available online through the Office of NCTracks. This crosswalk only serves as a preliminary guide.
 
The N.C. Division of Medical Assistance will add ICD-10 codes to clinical policies just before ICD-10 implementation on October 1, 2015. Some existing codes may change. Providers should check back for updates. Questions, comments? Email NCTracks-Questioner@dhhs.nc.gov.

 

 
  
 
EEedgeGetting enrollments approved: Nine tips for providers
  1. Verify the consumer does not have an existing Alpha ID before entering a consumer enrollment with a new ID number.
  2. If the consumer has active Medicaid, Smoky must have justification in the comment section for enrolling the person into the State Benefit Plan.
  3. The admission or diagnosis date cannot be prior to screening date.
  4. Identify the principal diagnosis.
  5. Confirm the requested target pops will not cause overlapping with current target pops in AlphaMCS.
  6. Verify the consumer does not have an active state layer in AlphaMCS.
  7. Record a consumer's physical address on the enrollment.
  8. The "maiden name" field must be completed for female consumers. If there is no maiden name, use the same last name.
  9. If an appointment is scheduled, make sure that information is completed on the enrollment.
Need help?
For claims-related questions, contact your assigned claims specialist via phone or email.
If you do not know your assigned specialist, use the general contacts in this section.
For general claims information

 

Send an email to us at: claims@smokymountaincenter.com or call 828-225-2785, ext. 2455.
For enrollment and eligibility

 

Send an email to us at: eande@smokymountaincenter.com or call 828-225-2785, ext. 2355. 
Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual or 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 help with services, call 1-800-849-6127, 24 hours a day (TTY: Relay NC at 711). Visit us at www.smokymountaincenter.com.