Please read if you deliver Medicaid-funded or State-funded (IPRS) Behavioral Health services:
On July 1, 2012, Crossroads Behavioral Healthcare, Mental Health Partners and Pathways LME merged to become Partners Behavioral Health Management. Beginning in January, Partners BHM will serve as a Managed Care Organization (MCO) that manages Medicaid and State funds (IPRS) for enrollees whose county of Medicaid eligibility is Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry or Yadkin.
At this time, providers and medical entities offering behavioral health services will have to be credentialed and contracted with Partners to be able to bill for services to enrollees who have Medicaid and/or want to provide services that are funded with an IPRS contract. If you are a licensed independent practitioner, a provisionally licensed practitioner employed by an agency, an agency that provides mental health/substance abuse enhanced and basic benefit services, , a hospital that provides emergency, outpatient and inpatient services to behavioral health consumers, a licensed ICF/MR facility, and/or an agency that currently provides CAP MR/DD services to consumers with Medicaid from one of the counties in the merged Partners area, you will be required to submit an application to be credentialed and have a contract with Partners.
Who will be in the Partners Network? On January 1, 2013 the merged entity will become a 1915 (b)(c) waiver site and those that wish to bill Medicaid funds and receive IPRS funding must have submitted an application that is approved and have a contract with them.
What does this mean for Providers? Applications will be accepted until January 1, 2013, at which time the network will close. Providers who submit a completed application by October 3, 2012, and are in compliance with the application and enrollment conditions and terms, will be assured that they will have the documents and billing information necessary to file claims with the MCO beginning January 1, 2013. Those that do not submit a completed application by October 3, 2012, will need to have a plan to transition their consumers.
The enrollment process to become a provider in Partners BHM’s Provider Network is open at this time to those behavioral health providers that have provided and billed a Medicaid behavioral health service within 60 days of the enrollment application to a Medicaid enrollee whose county of Medicaid eligibility is within Partners BHM's catchment area. Documents can be located at www.partnersbhm.org/providers/provider-enrollment.aspx.
REMEMBER: IF YOU CHOOSE NOT TO PARTICIPATE IN THE PARTNERS PROVIDER NETWORK, YOU WILL BE UNABLE TO RECEIVE MEDICAID REIMBURSEMENT FOR SERVICES RENDERSED ON OR AFTER JANUARY 1, 2013, FOR ENROLLEES WHOSE COUNTY OF MEDICAID ELIGIBILITY IS BURKE, CATAWBA, CLEVELAND, GASTON, IREDELL, LINCOLN, SURRY OR YADKIN.
If you have specific questions, please email firstname.lastname@example.org or call 1-877-864-1454, option 4, option 1.