 |
|
|
|
|
|
VOL. 1, ISSUE 7 | OCTOBER 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.
  Connect with us on LinkedIn and Facebook
 September 2015 data |
|
Denial spotlight - 27: Invalid National Provider Identifier
 Background: This denial occurs when the National Provider Identifier (NPI) on the claim is not in the system. It also occurs when the NPI is not associated with the main site on the claim for the date of service.
What causes this denial? AlphaMCS looks at the provider ID and NPI numbers in the claim header and then verifies that the provider ID in the claim header is matched to a site. After verifying the provider ID, AlphaMCS verifies that the provider NPI in the header is matched to a site. AlphaMCS then verifies that the provider ID and NPI numbers in the header have a matching provider in the database. If a unique match is not found, the claim will deny.
How do I correct this? Verify that the provider NPI is correct on claims and is valid for the service billed. Verify that the NPI being billed is associated with the correct provider in AlphaMCS. If information should be updated, contact Smoky's Provider Network Department as soon as possible.
|
Reminder: Clinician licensing and credentialing
 If your agency contracts with clinicians, please check AlphaMCS and NCTracks periodically for up-to-date licensing and credentialing information. Claims processing is a two-step process: Smoky receives claims from providers through AlphaMCS, then sends them to the state via NCTracks to receive payment. If the clinician information in either system is not current, claims can deny.
Updating clinician information the responsibility of providers; Smoky cannot submit licensing and credentialing changes. Changes and updates to NCTracks must be submitted through a "Manage Change Request". Forms and information are available on the NCTracks Provider Portal. Taking time to review clinician status can prevent future claim resubmissions or recoupments. If NCTracks has not been updated with your request(s) after 10 days from the date of contact with your Claims Specialist, Smoky will recoup for the claim(s). Thank you for your assistance to make claims processing as smooth as possible.
|
|
System issues: Medical Detox and Psychiatric Residential Treatment Facilities (PRTF)
Due to system issues, Medical Detox and PRTF claims are not processing correctly. Smoky is aware of the problem and is working to ensure AlphaCM rectifies the situation as soon as possible. As AlphaCM works to correct the problem, it is important that providers continue to submit claims to avoid timely filing denials.
We will continue to inform you of updates and appreciate your patience.
|
Choosing an ICD diagnosis
Smoky staff cannot advise providers or billing representatives on choosing a diagnosis code. This determination can only be made by a qualified medical professional.
|
Transforming Care Conference: Evidence-Based Medicine
Smoky and the Mountain Area Health Education Center (MAHEC) will sponsor a conference October 27-28, 2015 to improve the practice of evidence-based medicine.
The event, "Transforming Care Conference: Evidence-Based Medicine and the Future of Behavioral Health and Intellectual Developmental Disabilities Care," is designed for mental health professionals, including substance use counselors, social workers, psychologists, marriage and family therapists, school counselors, intellectual or developmental disabilities (I/DD) professionals and anyone else interested in the subject. Early registration is open through October 20 at $125 per person for both days or $75 per person for the second day only. Group rates and discounted rates for supporters, peer support specialists and students are also available.
Practicing evidence-based medicine (EBM) incorporates provider expertise, clinical evidence and the values, culture and needs of the person receiving care. To help build strong and healthy communities all three components of EBM are needed to effectively support people with mental illnesses, substance use disorders and/or intellectual or developmental disabilities. The aim of the conference is to increase participants' competence in delivering truly person-centered, collaborative care while implementing evidence-based treatment in a way that improves care and outcomes for individuals and reduces the per capita costs of care.
Discounted room rates are available for conference participants at the DoubleTree Hotel (828-274-1800) and the Biltmore Village Lodge (828-277-1800). Please be sure to ask for the Smoky Evidence-Based Medicine Conference. The discounted rate offer expires October 3, 2015.
Take a virtual tour of these facilities at biltmorefarmshotels.com.
If you have questions or concerns about your room reservation, please contact Karen Lambert at 828-257-4481 or karen.lambert@mahec.net.
Parking will be limited. Please carpool when possible.
Please review the training brochure and register by visiting the MAHEC website.
|
When to specify ICD-9 or ICD-10
|
N.C. Council of Community Programs: Annual Pinehurst conference and exhibition on December 2-4
The N.C. Council of Community Programs yearly conference and exhibition in Pinehurst, N.C., is well known throughout the behavioral health and intellectual/developmental disabilities community with around 800 participants each year, but did you know the N.C. Council works hard to ensure relevant content, not just for LME/MCO members, but for the provider community, as well? This year is no different - providers, don't miss this year's conference.
- David Houle, world-renowned futurist, author and speaker will help everyone understand the best way to market and brand your services using the latest technology in a shifting healthcare market.
- Whole-person care - learn how you can work with your LME/MCO or other partners to design and implement a new approach to whole-person care.
- Survival skills for the modern market - get practical business advice and learn how to optimize your operations, focus on patient-centered care and how to tap into new markets beyond Medicaid and more.
- New state and federal Medicaid regulations - N.C. Medicaid healthcare will soon be managed by private companies, CMS is implementing sweeping regulatory managed care rule changes - learn how these changes affect you as a provider.
- Population health management - the shifts our world has seen demand care integration, outcomes and the ability to track your population's progress. Understand the "how to" tools you will need to compete in this market.
- A two-day track will cover the transformations taking place in North Carolina and at the federal level around I/DD services and regulations.
In addition to the great trainings, the N.C. Council's conference is also famous for networking - LME/MCOs and their staff, providers, hospital leaders, DHHS, Division of MH/I/DD/SAS, DMA, legislators, advocates, consumers - over 100 vendors - all in one place. Don't miss this conference and of course all that Pinehurst has to offer - all at major discounts!
Save on registration:
Get Early Bird registration rates available through November 2, 2015. If you register four staff, the fifth attends for free. Consumers receive 50 percent discounts. Act quickly - registration cut-off is November 17, 2015. Register today!
|
Are you using the correct target pop?
The ASWOM Target Pop is used for:
- adult women who are 18 years of age or older with a primary substance use disorder covered in the Benefit Plan Diagnosis Array, and
- would benefit from assessment, initiation, engagement, treatment, continuity of treatment services and/or supports for relapse prevention and recovery stability, and
- are currently pregnant, or
- have a dependent child or children less than 18 years of age, or
- are seeking custody of a child less than 18 years of age.
Providers must meet all requirements set forth in the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) for Women's Set Aside funds, except for crisis/detox services.
The ASWOM Target Pop can be used in conjunction with the Adult with Mental Illness (AMI), Adult Substance Abuse Treatment and Engagement (ASTER), Adult Substance Abuse Injecting Drug User/Communicable Disease (ASCDR) and Adult with Developmental Disability (ADSN) Target Pops only.
|
The Smoky Provider Advisory Council has established a workgroup to assist provider claims and billing staff with the AlphaMCS system and with Smoky. The Provider AlphaMCS User Group meets once a month by conference call, usually on the fourth Monday of the month.
The next user group conference call is scheduled for 1:00 p.m. on Monday, October 26, 2015.
To access the call, dial 1-877-885-3221 and enter code 6178667 when prompted.
If you are interested in receiving an agenda prior to the meeting, please contact the Provider AlphaMCS User Group facilitator:
Kyla Wells
Meridian Behavioral Health Services
Phone: 828-564-1923
For more information on the Smoky Provider Advisory Council, please visit the Smoky website.
|
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.
|
|
|
|
|
|
|
|
|
|
|
|
|
