Eastpointe June 21, 2017 10:00am until 1:00pm Webinar
112
Eastpointe June 21, 2017 10:00am until 1:00pm Webinar
Transcript of Eastpointe June 21, 2017 10:00am until 1:00pm Webinar
Eastpointe June 21, 201710:00am until 1:00pmWebinar
Welcome and Overview Karen Salacki
Eastpointe Provider Network Council Nicole Bauer
Eastpointe Consumer and Family Karen Salacki
Advisory Committee
External Operations Updates Karen Salacki
Mystery Shopper Projects Becky Womble
Claims and Funding Services Tammy Powers
NC Health Information Exchange and HIPAA Jennifer Lamm
Reminders
NCTRACKS and Taxonomies Melanie Weatherford
Acquisitions and Mergers Donita Myrick
Listing of Sex Offender Specific Evaluators
Request to Add a Service Mark Lloyd
Adding a Taxomony Code to a Site
Network Operations Updates Linda Hawley Isbell
Listserve changes
Next Provider Meeting Karen Salacki
Contact Information
Nicole Bauer
For Council Information: Go to www.eastpointe.net, then For Provider Community, the Eastpointe Provider Network Council Information
Contact Information: [email protected]
The Eastpointe Provider Network Council meets the 4th Wednesday of the month (except November and December)
They meet at Skill Creations, 2105 Royal Avenue, Goldsboro, NC Upstairs Conference Room
The Provider Council is planning to outreach to all providers in our network early next year to introduce themselves and provide some information.
Karen Salacki
CFAC has vacancies for Consumers or Family Members of consumers for the following counties:
Edgecombe
Wilson
Sampson
Scotland
Lenoir
If you have a member or their family member who is interested in serving on CFAC please contact Melissa Reese at [email protected] or (252)407-2469.
Karen SalackiChief of External Operations
Eastpointe offices will be closed on Tuesday, July 4, 2017 in observance of the holiday. Our Member Call Center will remain open during this holiday.
Our Provider Network is closed except for sites/services that Eastpointe has determined a current service need.
This is effective for Medicaid and State Services.
We are not currently adding new state contracts for the 2017/2018 Fiscal year.
We are not adding agencies or contracts for Licensed Independent Practitioners who have their own practice.
We are accepting applications for the following service needs:
Psychiatrist in private practice who provide Medicaid services.
We are accepting applications from Hospitals.
We are accepting Licensed Independent Practitioner applications from agencies who need to add an Outpatient Therapist.
Agencies may add a site to provide Outpatient Services.
Agencies may submit a request to Subcontract to add a Therapeutic Foster Home or Unlicensed AFL only if an Eastpointe member will be placed in the home.
The Division of Health and Human Services received a grant for MCO’s to utilize to be able to provide this new IPRS benefit plan.
We have added this to the contracts of all providers who currently have an IPRS contract with Eastpointe and who currently provide eligible Substance Abuse Services.
This new benefit plan was effective June 19, 2017.
We will not be adding any new IPRS contracts at this time but will be regularly reassessing needs with available resources to determine future expansion of providers.
If you have any questions about this new benefit plan please contact Network Operations.
Information about the requirements came out in LME–MCO Communication Bulletin #J232 and Eastpointe’s March Communication Bulletin.
Eastpointe sent letters to each provider in our network who has NP’s credentialed with Eastpointe.
We asked that all providers who have NP’s, not certified, submit the required information to us by April 14, 2017.
LME-MCO Communication Bulletin #J253 dated May 30, 2017 changed the required documentation of years of psychiatric care and prescribing experience under licensed psychiatric supervision including psychiatric assessments and psychotropic medication prescribing to three years instead of five years.
This is for non-certified NP’s who are billing Clinical Coverage 8C services.
If you have not yet submitted this information and you would like to be considered to provide services to Eastpointe members after July 1, 2017, please submit the following immediately:
A copy of their signed supervision plan with a North Carolina Licensed Psychiatrist that covers prescribing activities; and
Documentation of that they have 3 full-time years of psychiatric prescribing experience under psychiatric supervision including psychiatric assessments and psychotropic medication prescribing.
We will be end dating any non-certified NP’s who have not submitted their information on June 30, 2017 in our Alpha MCS system. Any NP who has been end dated in Alpha MCS will no longer be able to provide services to Eastpointe members or bill for services after June 30, 2017.
LME-MCO Communication Bulletin #J254 dated June 16, 2017 outlines changes to the Agency Monitoring Process.
The changes will be effective July 3, 2017.
This involves:National Accreditation
Plan of Correction
Licensed Agencies that are not Accredited
Changes in Tools
Post Payment Reviews
The Eastpointe Area Board unanimously approved a consolidation agreement with Cardinal Innovations Healthcare. Both organizations are committed to improving the health and well-being of special populations in North Carolina.
The next step is for regulatory approval by the Secretary of DHHS.
We encourage you to keep up to date on consolidation efforts by:
Attending monthly Provider Meetings
Reviewing Eastpointe Communication Bulletins
Reviewing list serve announcements
If you are not already signed up for our Listserve we encourage you to sign up immediately. Please make note of the changes to this process that will be discussed later in the meeting.
Keep your information up to date on our Provider Directory.
Becky Womble
We contacted all Licensed Independent Practitioners (LIPs) who have their own contract.
There were 17 LIPs who had one of the thefollowing issues:
Number had been disconnected
The number was for a different agency
Message stated to go to the ER or call 911
Number was someone’s personal cell phone not affiliated with the LIP
No one answered and no option to leave a voicemail
We called all Intensive In Home (IIH) Providers.
Eight providers did not respond to the After Hours call. The had the following issues:
Number had been disconnected
Number went to an answering service
Incorrect number
No number listed
We called all Assertive Community Treatment Team (ACTT) and Community Support Team (CST) providers.
11 providers did not respond to the After Hours call.
4 providers did not have an After Hours Crisis Number listed.
One provider’s Answering Service hung up on Eastpointe staff 4 times before taking a message. The message was never responded to by provider’s staff.
Provider emailed Eastpointe staff the next day rather than returning After Hours call as requested.
Other problems noted with the Provider Directory:Most providers do not have the following information listed under their agency:
Cultures Served
Operating Hours
Languages
Payer Sources Accepted
Presenting Disability
After Hours Calls NOT Answered
December 2016 March 2017 May 2017
17 8 11
If the Not Met issue is related to the After Hours Crisis number, it is being referred to Provider Monitoring.
If the Not Met issue is related to other missing information on the Provider Directory, we are currently providing technical assistance.
Please review your agency information on the Provider Directory for completeness and accuracy.
To add and/or correct any information, it is necessary to complete and submit the ProviderChange Form.
This form can be located on the Eastpointe website www.Eastpointe.net > Provider > Manual and Forms> Forms (click on Read More)> Downloadable Forms> Updating Provider Information> Eastpointe Provider Change Form for Provider Directory and Alpha.
Next Mystery Shopper Projects….
Claims and Funding Services
Tammy Powers
Claims that span across state fiscal year will need to be split. Example: A member authorized for YP821 is hospitalized from 06/27/17 through 07/04/17; two claims will need to be filed.
Claim oneBill Type: 0113 (hospital inpatient interim continuing claim) DOS 06/27/17-06/30/17 4 units
Claim twoBill Type 0114 (hospital inpatient interim last claim) DOS 07/01/17-07/04/173 units
Making Claim RefundsClaim refunds to Eastpointe should be processed via replacement claims or voids.
To process a full refund
• submit a void claim which will revert and recoup payment of the original claim.
To process a partial refund
• submit a replacement claim which will void the original claim and create and process a new claim in its place.
**To ensure accurate claims information, checks received for partial refunds will be returned and the refund amount deducted from the provider’s RA.
Full claim refunds should be mailed to
EastpointeAttn: Accounting514 E. Main StreetBeulaville, NC 28518
Always Complete and submit the refund form with the check. Include the reason the refund is being made Include any documentation to support the reason for the refund. Confirm the check amount matches the amount in claims you wish to
refund. Ensure ALL information on the refund check form is correct and legible.
FULL CLAIM REFUNDS submitted by check must be accompanied by Eastpointe’s Refund Check Form found on the Eastpointe website under “Contracting and Payment for Services”. DO NOT USE THIS METHOD FOR MAKING PARTIAL REFUNDS.
Fiscal Year 17 Cut-off for Submission of State Funded Services
The deadline to submit state funded claims for dates of service 7/1/16 - 6/30/17 will be the last scheduled check write cut-off in September.
These claims for FY 16/17 must be received by Eastpointe on or before 5 PM on Tuesday, September 19, 2017 to be considered for payment.
Cut-off for FY17 Time-Limit Override Requests State Funded Services
The cut-off for submitting timely filing override requests for FY17 state funded claims is Tuesday, October 10, 2017.
This includes dates of service 7/1/16 – 6/30/17.
Requests received for these dates of service after October 10, 2017 will be denied.
Jennifer LammQuality Management Department
A health information exchange is a secure and electronic network that gives authorized health care providers the ability to access and share health related information across a statewide information highway
The North Carolina Health Exchange Authority (NC HIEA) was created by the North Carolina General Assembly to oversee and administer the state designated HIE (NCGS 90-414.7)
By February 1, 2018, all Medicaid providers must be connected and submitting data to NC HealthConnex in order to continue to receive payments for Medicaid services provided
By June 1, 2018, all other entities that receive state funds for the provision of health services including local management entities/managed care organizations, also must be connected
Connected is when clinical and demographic information pertaining to services paid for by Medicaid and other state-funded health care funds are being sent to the NC HealthConnex at least twice daily. This can be accomplished either through a direct connection to NC HealthConnex or via a hub or EHR vendor
If you are a behavioral health provider that bills NC Medicaid for reimbursement for behavioral or mental health services, you are required to connect to NC HealthConnex by the required deadlines
The first step is to review and sign the Participation Agreement.
The second step is to have the technology in place.
The third step is to identify three points of contact within your medical practice that will collaborate with the NC HIEA to complete a successful connection
Alcohol or substance abuse programs that receive any type of federal assistance as outlined in 42 C.F.R. 2.12 cannot generally disclose data through an HIE fi the data would: 1) identify a patient as a alcohol or substance abuser and 2) if that data was obtained by an alcohol or substance abuse program for the purpose of treating, diagnosing or making a referral for the patient’s abuse problem
Providers can disclose that information in the event of an emergency if the requesting physician needs the information to treat the emergency condition pursuant to 42 C.F.R. 2.51 or if the patient has the specific disclosure in writing in compliance with 42 C.F. R. 2.31
Most behavioral health information is permitted to be shared through NC HealthConnex. However, the HIPAA Privacy and Security Rule requires that providers receive written authorization from a patient before psychotherapy notes can be disclosed to another party.
HIPAA requires your agency to have a Security and a Privacy Officer
The Privacy/Security Officer does not have to be the same person but you must have someone within your agency to fill these requirements
Your agency staff need to know who your HIPAA Privacy Officer and Security Officer is
Any time Protected Health Information is transmitted over the internet, it must be encrypted
Eastpointe has a secure email system that Providers may use
The Office for Civil Rights will continue with audits in 2017 and 2018
Have your reviewed your HIPAA policies and procedures recently?
Do you regularly conduct risk assessments for privacy and security for your agency?
Melanie Weatherford
Eastpointe can upload changes to NC TRACKS to add NPI, Taxonomy codes, and sites and the turn around for this submission is 24-48 hours if a Managed Change Request is not currently under review.
Please send the following information in writing on Agency Letterhead to [email protected]
Name of Agency- (name shown in NC TRACKS)
Date of Request
The letter needs to be signed and dated by the NC TRACKS Office Administrator (this must be identified and it is required that we have approval before we can proceed with uploading changes to NC TRACKS)
Email address
NPI
Tax ID
Effective Date
Site address
Zip plus 4
County
Phone number
Taxonomy
Licensure type if applicable ( for Licensed clinicians)
License number if applicable (for Licensed clinicians)
Effective and end date If licensure is applicable (for Licensed clinicians)
Provider Bed Type if applicable- (this applies to Residential Services)
# of beds if applicable (applies to residential services)
If you are experiencing issues with NC TRACKS such as delayed processing time with a Manage Change Request (MCR) please email [email protected] include the following information in the email so we can better assist you.
• Name of Agency or LIP with TAX ID
• NPI
• Date the Manage Change Request was submitted to NC TRACKS
• MCR ID Number (reference number) top left side of the NC TRACKS Provider Enrollment Form
• MCR Description ( provider enrollment, add address, add taxonomy)
• Please indicate the status ( in review, approved, denied, unable to submit)
All provider National Provider Identifier (NPI) numbers must be active and correct in NC TRACKS and have an associated Taxonomy number.
Due to future requirements from the state related to encounter claims, Eastpointe must ensure compliance with these numbers.
An active and correct NPI is required to continue to receive payment from Eastpointe for dates of service on and after July 1, 2017 with the affected NPI numbers.
Effective immediately, all providers need to verify their billing and rendering enrollment NPI numbers are: Active in NC TRACKS and Under the Medicaid Benefit Plan in NC TRACKS.
Verifying information can be completed in NC TRACKS and addressing any NC TRACKS termination issues thru the NC TRACKS “ Manage Change Request” process.
NPI numbers that are not active in NC TRACKS and enrolled in an eligible benefit plan will be de-activated in Alpha which will result in claim denials for dates of service beginning July 1, 2017 if an NPI number is: Terminated in NC TRACKS and/or Terminated in the Medicaid Benefit Plan in NC TRACKS.
Once a number has been deactivated in the Alpha System, providers will be responsible for notifying Eastpointe that the issue(s) has been corrected in NC TRACKS. This will allow Eastpointe to re-activate the NPI number in Alpha.
To initiate this process, updated information must be submitted on agency letterhead to [email protected]
Submitted request should state the items corrected in NC TRACKS and your agency’s request to reactivate the impacted NPI number. Please ensure that the effective date of your NC TRACKS request runs consecutively with the end date so there is no lapse in coverage dates or a risk of recoupment for that period.
Taxonomy numbers that are being billed on the claim at the billing and rendering/attending level must have an associated taxonomy that is linked to the NPI and site location in NC TRACKS.
If the taxonomy that is being used is not connected to the NPI number and site, then the claim will be denied.
Donita Myrick, MS, MA
When a contracted Eastpointe provider wants to consider an acquisition or merger with another agency, it is critical that Network Operations is contacted before any changes occur.
Prior approval from Eastpointe is required before making this change.
Acquisition and Mergers
The process for receiving approval for Acquisition and Mergers, includes Licensed Facilities if another provider wants to acquire the facility from the current provider. Once this occurs the current facility must release the Letter of Support that they were given. This mean that they cannot open another facility without submitting another Letter of Support and have it approved.
Acquisitions and Mergers
Please note that there are many variables for Eastpointe to consider when a provider(s) are pursuing a acquisition and merger including:
Capacity
Good Standing
Whether one of the providers involved is not a member of our network.
Whether one of the providers involved is not a Good standing with Eastpointe.
Donita Myrick, MS, MA
Sex Offender Treatment is a service that can only be provided by clinicians that have specific training and certification.
The clinician must be a Certified Sex Offender Treatment Specialist (COSTS) or a Clinically Certified Sex Offender Treatment Specialist (CCSOTS) in order to provide sex offender evaluations and treatment.
If a clinician have either a COSTS or a CCSOTS and would like to provide services to these members, please submit their information to Eastpointe using the Sex Offender Treatment Services Form.
Please include a copy of their current certificate, showing an active certification.
The Sex Offender Treatment Services Form is available on the Eastpointe website, located under Provider >Manuals > and Forms >Forms > Updating Provider Information, and then submit to Network Operations via email or fax.
We are reviewing the Specialty Services selected by agencies on the Provider Change Form to determine which agencies reported the ability to provide Sex Offender Treatment
If we do not have record of a clinician with a COSTS or CCSOTS certification at your agency, we will remove this specialty from you agency.
Request to Add Service
Submit Letter via email:
Letter should be typed on Agency
Letterhead
Letter should include appropriate Date
Letter should include appropriate Signature
& Position
Letter should include:
The name and service code for the service
that you are requesting
The appropriate funding source for
requested service (Medicaid or State)
The site name you are asking to add the
service to
The site number (found in Alpha under Sites
Tile and also under the Site Tab)
Letter should include (continued):
The NPI number for this service
The taxonomy code for this service
The effective date that you are requesting
for this service
Reason you are making request
Attach a current copy of your Certificate of
Insurance (COI)
Please submit all Requests via email to
[email protected] with a
subject line: Add Service – Agency Name
and Service/Code(s):
Questions
Please submit any questions in writing to
[email protected] with
a subject line: Add Service Question
Contact Information:
Mark Lloyd at 1-888-977-2160
Network Operations:
Adding/Updating a Taxonomy Code
Submit Letter via email:
Letter should be typed on Agency
Letterhead
Letter should include appropriate Date
Letter should include appropriate Signature
& Position
Letter should include:
The agency name
The date of the request
The site name
The site number (found in Alpha under Sites
Tile and also under the Site Tab)
Letter should include (continued):
The NPI number
The taxonomy code to update
Please submit all Requests via email to
[email protected] with a
subject line: Taxonomy Code–Agency Name
Questions
Please submit any questions in writing to
[email protected] with
a subject line: Taxonomy Codes
Contact Information:
Mark Lloyd at 1-888-977-2160
Network Operations:
Linda Hawley IsbellDirector of Network Operations
LME-MCO Communication Bulletin #J247 dated April 28, 2017 outlined the changes to NCI.
NCI is used for de-escalation strategies to prevent the use of restraints and seclusion, and to prevent injury to the people we serve and to the workforce when restrictive interventions are used.
Effective July 1, 2017 NCI will be released to the public and will no longer be supported by DMH/DD/SAS.
Effective July 1, 2017, all providers currently using NCI will either need to:
Choose another DMH/DD/SAS approved curriculum (if you do this you must get permission to use the curriculum) or
May modify the current NCI curriculum and submit with a new name and changes or
Develop a new curriculum to DMH/DD/SAS for review.
If you are currently using NCI please submit on your letterhead a notification to Eastpointe to [email protected] to notify us which of the following you or your agency intend to choose by July 31, 2017:
Choose another DMH/DD/SAS approved curriculum (if you do this you must get permission to use the curriculum) or
May modify the current NCI curriculum and submit with a new name and changes or
Develop a new curriculum to DMH/DD/SAS for review.
We would like to make sure that we are covering topics of interest to our Provider Network in our monthly provider meetings. Please send any topics that you would like discussed to [email protected] .
Please indicate in the subject line : Provider Meeting Topics
NC Medicaid Electronic Health Record Incentive Program Announcement for 2017.
Affiliation Claim Edit and Edit Capacity-Clarification.
Provider Qualifications and Requirements Checklist.
Re-Credentialing Due dates for 2017
Medicaid and N.C. Health Choice Provider Fingerprint-based Criminal Background Checks
Clinical Coverage Policies
What it Means to be Audited by Centers for Medicare & Medicaid Services
Medicaid Behavioral Health Provider Enrollment
Maintain Eligibility Process
Abbreviated Application for Ordering, Prescribing and Referring Practitioners
We are changing our courtesy letter related to Re-Credentialing from 60 days prior to the end date of Credentialing to 90 days prior. Please remember that this is only a courtesy.
We must receive all complete Re-Credentialing applications 60 days prior to the LIP’s Credentialing end date or you will be at risk for a gap.
We will not back date the Re-Credentialing date and the LIP will not be able to see Eastpointe members or bill for services except for those delivered on or after the effective Re-Credentialing date.
The information in the Provider Directory comes from the information in Alpha.
This includes the After Hours Crisis number that your members, their family members or someone in the community may call when a member is in crisis.
Utilize the Eastpointe Provider Change Form on our website.
Please be sure to use the most up to date form that was revised.
To locate the form go to our website www.Eastpointe.net then go to Provider then Manuals and Forms and then Forms then Updating Provider Information.
Complete the Eastpointe Provider Change Form for Provider Directory and Alpha.
Is your After Hours Crisis number correct?
Is your STR contact correct?
Have you indicated which counties that you serve?
What Culturally Diverse Populations do you feel competent to serve?
What languages are you able to communicate in?
What are your specialty areas?
This is a very important time to sign up for Listserve.
Directions for signing up for list serve:
1. Go to Eastpointe’s website at http://www.eastpointe.net
2. Click on Provider
3. Then click on Manuals and Forms
4. Then click on Listserve Announcements
5. Go to: Sign up to join the Eastpointe Listserve!
6. Enter your email address (make sure you type it correctly), enter your first
and last name, and agency
7. Click on the Sign Up button
8. After you sign up, a Thank you page will open. You have been added to the
mailing list and can exit
You will receive an email that your request has been submitted
Please remember to register for Provider Meetings on our website
Under Provider Community
Then Calendar of Events
Our next meeting is scheduled for July 19, 2017from 10:00am until 1:00pm and this meeting will be a webinar.
Please contact Network Operations Call Center at
(888) 977-2160 or
Fax: 252-407-2450
Member Call Center 800-913-6109
Fax: (910) 345-8971
Visit our website www.eastpointe.net to locateCommunication Bulletins
Manuals
Provider Meeting PowerPoint’s
Provider Forms
Training Announcements and Sign Up
Provider Choice Database
And so much more
