Chester Clinic

Providers.partnersbhm.org

Provider Forum
January 13, 2015
1:00 PM
Welcome and Updates
Beth Lackey, Provider Network Director
NCTRACKS and Taxonomies
Gap Analysis/Needs Assessment
IPRS Utilization Analysis
B3 Funds
PBHM Performance Measures
Credentialing/Enrollment/CAQH
Relative as Direct Support Employee Larry Holcombe, Provider Network Manager
Updates
Transitions to Community Living
Regina Haynes, Care Coordination Supervisor
Learning Collaboratives
Stacy Bryant, Communications Officer
Partners Training Academy
Janet Noblett, Training Coordinator
Jackie Copeland, Waiver Contract Manager
Provider Council
Kevin Oliver/Margaret Mason
Western Regional Partnership
Paul Caldwell, Chief Community Relations Officer
Miscellaneous/Wrap Up
North Carolina Department of Health and Human Services
Aldona Z. Wos, M.D. Ambassador (Ret.) Division of Mental Health, Developmental Division of Medical Assistance Disabilities and Substance Abuse Services 2501 Mail Services Center 3001 Mail Services Center Raleigh, North Carolina 27699-2501 Raleigh, North Carolina 27699-3001 Tel 919-855-4100 Fax 919-733-6608 Tel 919-733-7011 Fax 919-508-0951 Robin Gary Cummings, M.D. Courtney M. Cantrell, Ph.D. Deputy Secretary for Health Services Director, Division of Medical Assistance MCO Communication Bulletin #J114
Mabel McGlothlen, LME System Performance Team Leader, DMH/DD/SAS, and Kathy Nichols, Lead Waiver Program Manager, Contracts Section, DMA Provider Enrollment The purpose of this bulletin is to inform that providers are now able to update their provider record in NCTracks via the managed change request process that can be accessed through the provider portal. Please encourage all providers in your network to keep their records up to date. This will assist in ensuring accurate data and will allow for more seamless encounter data transmission. LME-MCOs will be able to receive updates to the provider file via the weekly Global Provider File (GPF) interface transmission from NCTracks. Cc: Robin Gary Cummings, M.D., DMA Dave Richard, DHHS DMA Leadership Team DMH/DD/SAS Leadership Team Mary Hooper, NCCCP An Equal Opportunity / Affirmative Action Employer North Carolina Department of Health and Human Services
Aldona Z. Wos, M.D. Ambassador (Ret.) Division of Mental Health, Developmental Division of Medical Assistance Disabilities and Substance Abuse Services 2501 Mail Services Center 3001 Mail Services Center Raleigh, North Carolina 27699-2501 Raleigh, North Carolina 27699-3001 Tel 919-855-4100 Fax 919-733-6608 Tel 919-733-7011 Fax 919-508-0951 Robin Gary Cummings, M.D. Courtney M. Cantrell, Ph.D. Deputy Secretary for Health Services Director, Division of Medical Assistance MCO Communication Bulletin #J115
Mabel McGlothlen, LME System Performance Team Leader, DMH/DD/SAS, and Kathy Nichols, Lead Waiver Program Manager, Contracts Section, DMA Subject: Taxonomy The purpose of this bulletin is to outline the process for how to use the updated taxonomy list. During our recent Core Team calls, we discussed issues with taxonomies and their impact on denied claims (this applies to Medicaid Encounter claims, not claims where DMH/DD/SAS would be the payer). To address this issue, your agency was asked to submit a list of the current taxonomies. Staff at DMA then reviewed those taxonomies and provided a list of taxonomies cross-walked with those in the NCTracks system that should not deny claims. The compiled list is not expected to be a comprehensive list of taxonomies that would not be accepted but a stepping stone toward getting a greater proportion of encounter claims to process to acceptance. This clarification comes as a result of the Core Team discussions and is intended to help inform LME-MCO staff how they should use the taxonomy crosswalk list. Once LME-MCOs modify their systems to stop submitting codes not accepted by NCTracks, DMA will reprocess these claims that were previously denied. When the claims are reprocessed, NCTracks will replace the disallowed taxonomy with the cross-walked taxonomy. Where the old taxonomy cross-walks to "exclude," the claim would be denied. In order to streamline this process, LME-MCOs shall: 1) Change your claims processing systems to disallow all the taxonomies for Medicaid
reimbursement that were on the list and provide DMA a date when the change will be
implemented into your system.
 This is an important step that will help ensure that the system is in line with that of NCTracks when it comes to provider taxonomies.  Presumably, the provider would receive an Explanation of Benefits (EOB) outlining the reason An Equal Opportunity / Affirmative Action Employer Page 2 of 2 Re: Taxonomy January 9, 2015 2) Work with any providers using the disallowed taxonomies to identify an NCTracks accepted
taxonomy that providers can bill.
 The LME-MCO should instruct their providers to log on to the NCTracks Provider Portal to verify their information including their taxonomy code(s).  If any of their information in NCTracks needs to be updated, they need to fill out a Managed Change Request (MCR) while in the NCTracks Provider Portal, then notify the LME-MCO of the changes.  The LME-MCOs should reinforce to their contract providers that the providers are now responsible for maintaining and updating their information in NCTracks, as well as reporting changes to the LMC-MCO. 3) Educate and work with providers to ensure that what is submitted is both legitimate and accepted
by NCTracks.
LME-MCOs are not being asked to alter any claims information that is sent to them, but might need to
assist the provider to ensure that they have entered legitimate claims that NCTracks will accept. For
example, 103TA0400X is not accepted but 103T00000X is sufficient. Both are taxonomies for
Psychologists, but the one that NCTracks does not accept is more specific. As another example,
101YP1600X is Pastoral Counselor and there could possibly be no other taxonomies that would fit that
provider. If that is the case, then DMA will not pay for service for such a provider. For one last
example, 208M00000X is a Hospitalist. In the crosswalk, DMA listed 208000000X, which is
Pediatrics. This does not mean that all Hospitalists should be enrolled under the Pediatrics taxonomy.
Rather, the provider should see if there is an appropriate taxonomy that is in the list that NCTracks
approves.
If you have questions regarding this request, please send them via electronic mail to: o Cc: Robin Gary Cummings, M.D., DMA Dave Richard, DHHS DMA Leadership Team DMH/DD/SAS Leadership Team Mary Hooper, NCCCP An Equal Opportunity / Affirmative Action Employer North Carolina Department of Health and Human Services
Aldona Z. Wos, M.D. Ambassador (Ret.) Division of Mental Health, Developmental Division of Medical Assistance Disabilities and Substance Abuse Services 2501 Mail Services Center 3001 Mail Services Center Raleigh, North Carolina 27699-2501 Raleigh, North Carolina 27699-3001 Tel 919-855-4100 Fax 919-733-6608 Tel 919-733-7011 Fax 919-508-0951 Robin Gary Cummings, M.D. Courtney M. Cantrell, Ph.D. Deputy Secretary for Health Services Director, Division of Medical Assistance MCO Communication Bulletin #J116
Mabel McGlothlen, LME System Performance Team Leader, DMH/DD/SAS, and Kathy Nichols, Lead Waiver Program Manager, Contracts Section, DMA Associate Level Licensed Providers: Direct Enrollment
The purpose of this bulletin is to notify associate level licensed providers that they must directly enroll by June
30, 2015 to provide Medicaid and state funded outpatient behavioral health services.
Associate level licensed providers must apply and enroll through the LME-MCO with which they wish to
contract. Effective July 1, 2015, if the associate level licensed provider wishes to provide services to Medicaid
beneficiaries age 0 to 3, Health Choice beneficiaries, or legal aliens, the associate level professional must enroll
with DMA by contacting Computer Sciences Corporation (CSC).
The associate level licensed provider will need to be enrolled with both DMA (through CSC) and the LME-
MCO if they wish to provide services to multiple populations.
 The Division of Public Health provides services to individuals who are age 0-3 and are not Medicaid or Health Choice eligible.  DMH/DD/SAS provides services to individuals who have had their third birthday and older. Associate level licensed providers enrolling with DMA (through CSC) or the LME-MCO will enroll under the taxonomy code of their respective profession. For example, the Associate Level Licensed Clinical Social Worker will enroll under the taxonomy code for a Licensed Clinical Social Worker. An Equal Opportunity / Affirmative Action Employer Re: Associate Level Licensed Providers: Direct Enrollment January 9, 2015 For claims submitted through NC Tracks, the rate for the associate level licensed provider is the same as the rate for their fully licensed counterpart. However, LME-MCOs have the ability to set their own rates for services. Therefore, associate level licensed providers should contact the LME-MCO for information regarding rates. Associate level licensed providers will need to obtain their own National Provider Identifier (NPI) number if they do not have one. To apply for an NPI number, please see the instructions on the following website  Associate level licensed providers may contact CSC (1-800-688-6696) with questions regarding enrollment with DMA.  Associate level licensed providers should contact their LME-MCO regarding enrollment. As outlined in section 6.2 of the outpatient Clinical Coverage Policy 8C, associate level licensed providers are allowed to bill "incident-to" their supervising physician or bill through the LME-MCO until the associate level licensed provider is able to directly enroll with the LME-MCO. The policy states that when the associate level licensed provider is able to direct enroll, then DMA will discontinue the associate level license provider "incident to" policy. The "incident to" policy change will not impact providers receiving state-funded reimbursement as DMH/DD/SAS does not support "incident to" billing. Associate level licensed providers will be able to continue billing "incident to" their supervising physician for Medicaid or bill HCPCS codes through a willing LME-MCO for Medicaid and/or state-funded behavioral health outpatient services until they have completed direct enrollment, or until June 30, 2015, whichever comes first. Effective July 1, 2015: 1. DMA will change the outpatient Clinical Coverage Policy 8C and remove the section on "incident to" billing for associate level licensed providers as well as remove the section allowing associate licensed level providers to bill HCPCS codes (H0001, H0004 + modifiers, H0005 and H0031) through the LME-MCO. 2. DMH/DD/SAS will also eliminate HCPCS code billing through the LME-MCO for state-funded outpatient services at the same time.
All associate level licensed providers are required to have supervision from a supervisor approved by their
licensing board. This supervision is critical to ensuring quality of services for beneficiaries being served by
associate level licensed providers. Each associate level licensed provider is required to ensure that they meet the
supervision requirements set forth by their respective licensing board.
The links to the rules pertaining to the respective board's supervision requirements found in the North Carolina
Administrative Code are as follows:

Marriage and Family Licensure Board:

Substance Abuse Professional Practice Board:

An Equal Opportunity / Affirmative Action Employer Re: Associate Level Licensed Providers: Direct Enrollment January 9, 2015 North Carolina Board of Licensed Professional Counselors:

North Carolina Social Work Certification and Licensure Board:


If you have questions, please contact Kathy Nichols at:for Medicaid and
Health Choice related questions, and Mabel McGlothlen at:for state-funded
questions.

Cc:
Robin Gary Cummings, M.D., DMA Dave Richard, DHHS DMA Leadership Team DMH/DD/SAS Leadership Team Mary Hooper, NCCCP An Equal Opportunity / Affirmative Action Employer North Carolina Department of Health and Human Services
Aldona Z. Wos, M.D. Ambassador (Ret.) Division of Mental Health, Developmental Division of Medical Assistance Disabilities and Substance Abuse Services 2501 Mail Services Center 3001 Mail Services Center Raleigh, North Carolina 27699-2501 Raleigh, North Carolina 27699-3001 Tel 919-855-4100 Fax 919-733-6608 Tel 919-733-7011 Fax 919-508-0951 Robin Gary Cummings, M.D. Courtney M. Cantrell, Ph.D. Deputy Secretary for Health Services Director, Division of Medical Assistance MCO Communication Bulletin #J117
Mabel McGlothlen, LME System Performance Team Leader, DMH/DD/SAS, and Kathy Nichols, Lead Waiver Program Manager, Contracts Section, DMA Clarification of Joint Communication Bulletin #J098: MCM
The purpose of this bulletin is to describe some options to address the assessment and discharge planning
functions necessary in a hospital ED environment without utilizing mobile crisis management:
1. Contract with independent practitioner (LCSW, LPC, Psychologist) to offer outpatient evaluations and discharge on an on-call basis in the ED. 2. Embed an administrative-level individual (or place them on-call to work with ED without necessarily having to be IN the ED) to coordinate discharge and follow-up to ensure aftercare is received. For example, non-clinical care coordination staff could make phone calls to help arrange aftercare transportation and communicate with existing providers for the individual being discharged from the ED. 3. Use identified STR staff specifically for this purpose; it might work well for an ED that has Please note that section 6.13 of the LME MCO contract states: PIHP shall coordinate and monitor Behavioral Health hospital and institutional admissions and discharges, including discharge planning. An alternative service definition may also be an option that can be discussed with DMA. An Equal Opportunity / Affirmative Action Employer Page 2 of 2 Re: Clarification of Joint Communication Bulletin #J098: MCM January 9, 2015 Please direct any questions to Cc: Robin Gary Cummings, M.D., DMA Dave Richard, DHHS DMA Leadership Team DMH/DD/SAS Leadership Team Mary Hooper, NCCCP An Equal Opportunity / Affirmative Action Employer

N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes
Effective with an estimated date of service of January 1, 2015, the N.C. Division of Medical Assistance (DMA) will
make changes to the N.C. Medicaid and N.C. Health Choice (NCHC) Preferred Drug List (PDL). It is the
expectation of Partners Behavioral Health Management that providers are aware of the importance of
prescribers prescribing medications that are covered by a patient's insurance, in an effort to reduce risk of the
patient not filling/taking medication because they cannot afford it and to increase medication adherence. The
following list is available in the December 2014 Medicaid Bulletin available using the following link:

Below are highlights of some of the changes that will occur.  The prior authorization criteria will be removed from the leukotriene class  New classes are being added: o Under TOPICAL, Imidazoquinolinamines o Under MISCELLANEOUS, Epinephrine, Self-Injected; Estrogen Agents, Vaginal Preparations; Glucocorticoid Steroids, Oral  Some mental health pharmaceuticals will have non-preferred options for the first time. Below is what the PDL will look like January 1, 2015 ANTIDEPRESSANTS- Other
Preferred
bupropion (generic for Wellbutrin®) bupropion SR (generic for Wellbutrin SR®) bupropion XL (generic for Wellbutrin XL®) desvenlafaxine ER (generic for Pristiq®) duloxetine (generic for Cymbalta®) maprotiline (generic for Ludiomil®) Effexor XR® Capsules mirtazapine (generic for Remeron®) Corporate Office Elkin Region Office Hickory Region Office 901 South New Hope Rd. 200 Elkin Business Park Dr. 1985 Tate Blvd. SE, Suite 529 Gastonia, NC 28054 Hickory, NC 28602 Administration: 1-877-864-1454 • Customer Services: 1-888-235-HOPE (4673) • Website: ANTIDEPRESSANTS- Other
Preferred
phenelzine (generic for Nardil®) nefazodone (generic for Serzone®) tranylcypromine (generic for Parnate®) trazodone (generic for Desyrel®) venlafaxine (generic for Effexor®) venlafaxine ER capsules (generic for Effexor XR venlafaxine ER tablets (generic for Effexor ANTIDEPRESSANTS -Selective Serotonin Reuptake Inhibitor (SSRI)
Preferred
citalopram (generic for Celexa®) escitalopram tablet (generic for Lexapro® fluoxetine capsule (generic for Prozac® escitalopram solution (generic for Lexapro® fluoxetine solution (generic for Prozac® fluoxetine DR 90mg Caps (generic for Prozac fluvoxamine (generic for Luvox®) fluvoxamine ER (generic for Luvox CR®) paroxetine (generic for Paxil®) sertraline (generic for Zoloft®) paroxetine CR (generic for Paxil CR®) ANTIHYPERKINESIS
Preferred
amphetamine salt combo XR capsules (generic for Adderall XR) amphetamine salt combo tablets (generic dexmethylphenidate (generic for Focalin®) clonidine ER (Kapvay®) dexmethylphenidate XR (generic for Focalin® dextroamphetamine ER (generic for Dexedrine dextroamphetamine solution (generic for Dexedrine Spansules® dextroamphetamine (generic for methamphetamine (generic for Desoxyn®) Methylin Chewable Tablet® methylphenidate CD capsules (generic for methylphenidate LA capsules (generic for methylphenidate solution (generic for Methylin® Soluton) ANTIHYPERKINESIS
Preferred
Methylin Solution® methylphenidate ER tablets (generic for methylphenidate ER tablets (generic for methylphenidate tablets (generic for Methylin®/Ritalin®) ATYPICAL ANTIPSYCHOTICS
Injectable Long Acting
(Trial and Failure of only 1 preferred required)
Preferred
Abilify Maintena® fluphenazine decanoate (generic for Prolixin Haldol decanoate® haloperidol decanoate (generic for Haldol Invega Sustenna® Risperdal Consta® Zyprexa Relprevv® ATYPICAL ANTIPSYCHOTICS
(Trial and Failure of only 1 preferred required)
Preferred
clozapine (generic for Clozaril®) Fanapt® Titration Pack clozapine ODT (generic for FazaClo®) olanzapine/fluoxetine (generic for olanzapine (generic for Zyprexa®) olanzapine ODT (generic for Zyprexa® Zydis) quetiapine (generic for Seroquel®) risperidone (generic for Risperdal®) risperidone ODT (generic for Risperdal M®) ziprasidone (generic for Geodon®) If you have a patient who is stable on a non-preferred product, and want them to continue on it, you may fill out a standard drug request prior authorization form found at These forms will be accepted beginning December 1, 2014. Forms must be submitted by December 30, 2014 to have approved prior authorizations active in the system by January 1, 2015. 1. Update on preferred brands with non-preferred generic equivalents
In addition to the changes above, preferred brands with non-preferred generic equivalents will be updated and are listed in the chart below: Brand Name
Generic Name
Amphetamine Salt Combo ER Azelastine Hydrochloride Clindamycin/Benzoyl Peroxide Clonidine Patches Derma-Smoothe-FS Fluocinolone 0.01% Oil Brand Name
Generic Name
Dexedrine Spansules Dextroamphetamine Diastat/Diastat Accudial Valsartan / Hydrochlorothiazide Pioglitazone / Glimepiride Amlodipine / Valsartan Focalin / Focalin XR Dexmethylphenidate Griseofulvin Ultramicrosize Morphine Sulfate ER Brand Name
Generic Name
Methylphenidate CD Methylin Solution Methylphenidate Solution Metrogel Vaginal Metronidazole Gel Vaginal Lansoprazole / Amoxicillin / Clarithromycin Pulmicort 0.25mg/2ml, 0.5mg/2ml Budesonide 0.25mg/2ml, 0.5mg/2ml Methylphenidate ER Olanzapine / Fluoxetine Tobradex Suspension Tobramycin/Dexamethasone Susp Metoprolol Succinate Zovirax Ointment Acyclovir Ointment

NC TOPPS Timely Submission Compliance since Merger In July
(Partners Behavioral Health Management)
2014-15: 1st QTR
2013-14: 4th QTR
2013-14: 3rd QTR
2013-14: 2nd QTR
2013-14: 1st QTR
2012-13: 4th QTR
2012-13: 3rd QTR
2012-13: 2nd QTR
2012-13: 1st QTR
Enter Presentation Title

 The State benchmark for timely submission of NC  For the 1st quarter 2014-2015, Partners compliance is  Partners BHM currently had 116 Providers registered within the NC TOPPS system during the first quarter. (Multiple sites included)  This quarter 55 Providers met the 90% submission standard. 46 of the 55 Providers had 100% submission rate for compliance  It should also be noted that 43 Providers had no requirements for updates. NC TOPPS Superstars Agency Name
Agency City
% Received on Standard Met
A Caring Alternative Access Family Services, Inc. Gastonia Alexander Youth Network Alexander Youth Network Alexander Youth Network Barium Springs Home for Beaty Recovery Services NC TOPPS Superstars Agency Name
Agency City
% Received on
Standard Met
Burke Council on Alcoholism & Chemical Dependency Carolina Therapeutic Services, Inc. Children's Advocacy Children's Advocacy Clay, Wilson, and Associates/Cognitive Connection Cornerstone Treatment Facility Daymark Recovery Services Provider
Agency City
% Received on
Standard Met
Daymark Recovery Services Daymark Recovery Services Eliada Homes, Inc. Asheville Support Services, LLC Family NET of Catawba County FOCUS Behavioral Health Services, LLC Hudson NC TOPPS Superstars Provider Agency
Agency City
% received on
Standard Met
FOCUS Behavioral Health Services, LLC Gaston Adolescent Genesis House, Inc. Grandfather Home for Innovative Compliance Solutions NC TOPPS Superstars Provider Agency
Provider City
% Received on
Standard Met
New Hope Carolinas One Love Periodic Services Outreach Management Services Phoenix Counseling Center NC TOPPS Superstars Provider
Provider City
% Received on
Standard Met
Phoenix Counseling Phoenix Counseling Health Services, Inc. Forest City Clinical Counseling Services, Inc. Developmental Academy Strategic Interventions, Inc. Strategic Interventions, Inc. Enter Presentation Title Provider Agency
Provider City
% Received on
Standard Met
Strategic Interventions, Strategic Interventions, Strategic Interventions, The Children's Home, Inc. The Right Choice MWM, Inc. Enter Presentation Title Provider
Provider City
% Received on
Standard Met
Thompson Child and Top Priority Care Turning Point Homes Charlotte Youth Focus, Inc. Enter Presentation Title  NC-TOPPS Help Desk: Center for Urban Affairs &
Community Services, NC State University:  (919)-515-1310  Help Desk:  Partners BHM: Sheila Wall, Quality Management
Data Analyst, (Gastonia site):  (704)-884-2560   (please use only consumer MR#'s in emails-no identifying information!) Enter Presentation Title Enter Presentation Title

Source: http://providers.partnersbhm.org/wp-content/uploads/2016/07/2015-January-Provider-Forum-Handouts.pdf