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VOL. 1, ISSUE 4 | JULY 2015
Greetings from Smoky Mountain's Claims Team!
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  June 2015 data |
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 Denial Spotlight - 122: A specific site could not be determined Background: A claim is submitted through the 837 electronic file listing a site National Provider Identification (NPI) and ZIP+4 matching multiple sites.
What causes this denial? AlphaMCS requires the service facility NPI and the site ZIP+4 on submitted claims. The NPI and ZIP+4 must match a unique provider site location. If there are multiple matches, a specific site cannot be selected and the error is generated.
How do I correct the denial? Always verify that the NPI and ZIP+4 on 837 claims are correct. You can confirm the information is correct in AlphaMCS by contacting the Smoky Provider Network department. Claims may be resubmitted if corrections are necessary.
Provider Network can be reached:
Website: http://www.smokymountaincenter.com/credentialing/default.asp
Email: providerinfo@smokymountaincenter.com
Phone: 828-255-2785, ext. 1512 |
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Selecting diagnosis on a claim in AlphaMCS
Have you ever keyed a claim into the AlphaMCS Portal, certain the information was correct, yet it still denied for a multitude of "Invalid DX" reasons? This happens when the diagnosis code is entered manually without selecting the correct code from the drop down menu. AlphaMCS automatically begins populating possible choices when you start typing the diagnosis in the entry field. When the pre-populated choices appear, select the valid diagnosis from the drop down menu. |
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Time is running out! Are you ready for ICD-10?
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.
What will I learn?
- How to describe format changes between ICD-9 and ICD-10
- How to recognize challenges of cross walking DSM-5 and ICD-9 to ICD-10
- How to understand software system changes to accommodate ICD-10
- How to select testing strategies to ensure claim systems are ready for ICD-10
- How to use ICD-10 resources like the CMS general equivalence mappings (GEMS), the ICD-10 crosswalks in the DSM-5 manual and several ICD-10 websites
Registration is required. To register online, choose from the sessions below...
See the flyer to learn more, or call 828-225-2785 or email us at ICD10@smokymountaincenter.com.
Monday, August 10, 2015
8:30 a.m. to 3 p.m.
Check in from 8:00 to 8:30 a.m. Training will begin promptly at 8:30 a.m.
30-minute lunch (Box lunches available for $10. View the training flyer for more info.)
About the training:
The Provider Advisory Council of Smoky Mountain LME/MCO and OPTUM360 have partnered to provide an in-depth coding and billing training for providers.
Topics covered in the training include:
- Benefits of ICD-10-CM and differences with the Diagnostic and Statistical Manual of Mental Disorders (DSM)
- Guidelines, conventions and principles for key areas of focus: mental, intellectual and behavioral, nervous system, injury and poisoning and health status
- Processes for appropriate code selection
Registration is required. Seating is limited to 130 attendees. Webinar access will be available (limited to 45 participants). Visit the online registration page to secure your space today.
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CANCELED: Transforming Care Conference for providers: July 29-30 in Asheville
We regret to inform you that the Transforming Care Conference has been canceled. We will promptly inform you when this event has been rescheduled. |
Bulletin reminders:
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Make-up Session: NC Home and Community Based Services Provider Self-Assessment Training
Wednesday, August 5, 2015
1:00 to 4:00 p.m.
Smoky Mountain LME/MCO
200 Ridgefield Court, Suite 206
Asheville, North Carolina
 Smoky Mountain LME/MCO (Smoky) is offering a make-up session for providers who were unable to attend previous sessions on Home and Community Based Services (HCBS) Provider Self-Assessment training.
Led by Jesse Smathers, Smoky Innovations Technical Director, and Patty Wilson, Smoky Contract Performance and Special Investigations Senior Director, the training is designed for qualified professionals who manage Innovations services.
Please note, attendance is required for providers of Day Supports, Residential Supports and Supported Employment. To register, please email hcbs@smokymountaincenter.com or call Jesse Smathers at 828-225-2785, ext. 5923. View the flyer here. |
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Revised Consumer Admission and Discharge form
Effective July 1, 2015, all state LME/MCOs must capture additional data for consumers enrolling in the state benefit plan. The new requirements will affect the Consumer Admission and Discharge form, formerly known as the Standardized Consumer Screening, Triage, Referral and Registration form (STR).
The examples below show how the form has changed.
Previously, the response to Veteran status was Yes or No. Now you will choose from four options.
A question has been added to capture data on traumatic brain injuries (TBI).
A question was added to gather data on Mutual Aid Program Attendance (the number of times the client has attended a self-help program in the 30 days preceding the date of admission/discharge from treatment services).
For questions regarding the Consumer Admission and Discharge form, contact Eligibility and Enrollment at 828-225-2785, ext. 2355.
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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. |
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