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(de julio de 2012) Manual del cliente. Guía para entender el sistema de servicios de salud mental, discapacidades de desarrollo y abuso de sustancias de Carolina del Norte.
(Posted January 30, 2013) This Guide is designed to provide information about the services and supports funded through the NC Innovations Home and Community Based Waiver.
Posted January 31, 2013. This booklet offers information about the Individual and Family Directed Supports Options under the NC Innovations Waiver.
Posted Jan. 31, 2013--Notice of Privacy Practices for Enrollees in the Partners BHM Prepaid Inpatient Health Plan.
(Posted November 2012) The Partners BHM Consumer-Enrollee Handbook offers information about Partners, consumer rights and responsibilities, and information about services. All individuals receiving services should receive or review the handbook. If you need assistance or have questions about item covered in the Consumer Handbook, please contact a Consumer Relations Specialist at 1-877-864-1454.
(Revised June 14, 2013) This application allows agencies to request a Consumer Specific Agreement to serve a Partners BHM consumer. Receipt of a Consumer Specific Agreement does not award permission to serve additional consumers from Partners BHM.
(Posted Jan. 31, 2013)
(Phone numbers updated FEB. 1, 2013) This manual offers guidance to staff at hospitals operating in the Partners BHM Network.
This form should be used to register Hospital Based Licensed Independent Practitioners that only provide services in the ED or Inpatient Setting or when the Hospital has or is negotiating an Agreement for Credentialing with Partners Behavioral Health Management. All other LIPs must complete and submit the Partners BHM Uniform Licensed Independent Practitioner Application.
(Revised May 2013) For use during the telephonic Utilization Management Review of Psychatric Inpatient Service.
Revised May 2013.
(Posted June 14, 2013) Consumer Specific Agreement to be completed by Out-of-Network Hospitals serving Partners BHM enrollees.
(Posted May 22, 2013) This form should be used to register Hospital Based Licensed Independent Practitioners that only provide services in the Emergency Department or Inpatient Setting or when the Hospital has or is negotiating a Delegation Agreement for Credentialing with Partners Behavioral Health Management. All other LIPs must complete and submit the Partners BHM Uniform Licensed Independent Practitioner Application.
Revised March 1, 2013. This form is to be used by Hospitals and Facility Based Crisis Providers.
Tips to determine income and dependent information for individuals receiving State-Funded (IPRS) Services
This document outlines the State Funded (IPRS) Services Benefit grid for services effective July 2012.
This form was revised August 6, 2012.
Annual Fee Evaluation Data Collection Form and Financial Agreement Statement--NCGS §122C-146 requires the implementation of a co-payment schedule for publicly funded services. These rules were adopted to comply with the requirements of HB 628 Session Law 2011-145. Requirements are found in 10NCAC 27A.0501- 10NCAC 27A.0505.
(Posted June 14, 2013--effective June 17, 2013) Benefit Grid for State-Funded (IPRS) Services in Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin counties.
(Posted March 29, 2013) Rates for IPRS (State-Funded) services for the Partners BHM Network effective April 1, 2013.
This document was revised effective August 6, 2012.
The “Top Ten List” of Information that Partners Behavioral Health Management IPRS Providers Need for July 1, 2012.
For use by providers processing Medicaid Pass Through Billing with Partners BHM.
(Posted March 29, 2013) Effective April 1, 2013.
Posted February 25, 2013. Partners BHM's Rates and Codes for Medicaid B services.
(Updated May 20, 2013) The Rate Schedule for Medicaid C (NC Innovations) services is now located in the NC Innovations catagory.
(Posted June 14, 2013--effective June 17, 2013) Partners BHM's Medicaid Service Benefit Grid for 1915(b) and 1915(c) Waiver Prepaid Inpatient Health Plans.
Information for Providers who deliver services that cannot be billed directly to the Division of Medical Assistance.
(Posted May 29, 2013) This is a listing of providers delivering Agency with Choice services in the Partners BHM Network.
(Posted May 9, 2013) Vendors and Contractors used for procurement of NC Innovations Waiver Services must be included on Partners BHM's Approved Contractor-Vendor List.
(Posted May 29, 2013) List of providers delivering Community Guide services.
(Posted May 20, 2013) This document outlines Partners BHM's rates for NC Innovations services. This file replaces the Medicaid C Rate Schedule.
Presented at March Provider Forum-March 12, 2013. This PDF includes requirements, procedures and forms related to back up staffing for participantes in the NC Innovations Waiver.
Posted in Provider Bulletin#14 --March 28. This document contains clarification on situations related to back-up staffing needs.
Presented at the March Provider Forums. This PDF contains guidelines, procedures and forms related to care for participants of the NC Innovations Waiver when traveling out of the state.
(Posted May 9, 2013) This document outlines NC Innovations Services that are required to go through the Procurement Process and the process for procurement of such services.
Posted April 8, 2013. Providers employing a relative/legal guardian, living in the home of an adult (18 years) Innovations recipient and who is the direct support staff for that recipient, must comply with the Relative/Legal Guardian as Provider Process outlined in this document and submit requests to the Partners BHM Relative/Legal Guardian as Provider (RAP) Committee for approval.
Clinical Guidelines adopted by Partners Behavioral Health Management
(Posted May 1, 2013) Partners Behavioral Health Management has been meeting with local hospitals and mobile crisis team providers in the eight-county Partners BHM region to develop a strategy to improve clinical efficacy and reduce the number of people that come to the local Emergency Departments for a behavioral health crisis. Hospitals and Mobile Crisis teams in the Partners BHM catchment area were very helpful in the development of this plan, which will focus on two outcomes:
1. Reduce the number of behavioral health patients that come to the Emergency Departments for crisis management, and;
2. Increase the number of behavioral health crisis patients that are seen in the community before they arrive in the Emergency Departments, thereby diverting many away from the Emergency Departments.
Partners Behavioral Health Management has developed a comprehensive crisis strategy and strategic plan as a part of this analysis. This crisis strategy and plan is available in this link. Many solutions are contained in the strategic plan that will work synergistically to help all manage patients in crisis more rapidly and with more appropriate care.
(Revised May 20, 2013) Have a question about Partners BHM but do not know who to call? Check out this listing of primary topics and contacts.
Crossroads, Mental Health Partners, and Pathways are merging on July 1, 2012 to form Partners Behavioral Health Management. The following is important Provider information relative to the merger and operational processes beginning July 1, 2012.
Posted February 25, 2013. Direction regarding Associate Licensed Professional/H Codes; Provider Information Request --Relative/Legal Guardian as Direct Support Employee; LOCUS/CALOCUS/ASAM Reminders; Psychological Testing Guidelines; Person Centered Plans for Medicaid and IPRS; Use of 90785: Interactive Complexity; “New” and “Established” E/M Coding; Partners-Sponsored and DHHS-Sponsored Provider Trainings--LOCUS/CALOCUS, ASAM, Program Integrity for Providers; Partners Wants You to Know--Website Updates, New Enrollee Information, Customer Services/Access to Care Questions, Enrollee Education Sessions, March Provider Forums
Revised March 4 , 2013 (phone number correction.) IN THIS BULLETIN: Value Options Authorizations, Attention Outpatient Providers requesting Basic Benefit Services, Clarification on Unmanaged Visits and Psychological Testing, Important Information about 837 Files, Use of Local Modifiers for Authorizations; Partners BHM Wants You to Know:
NC DHHS DOJ ACT Implementation—Introduction to the Tool for Measurement of ACT; March Provider Forums; March Enrollee Education Sessions; Website Updates
Published March 15, 2013. Please open to view topics.
Posted March 25, 2013. IN THIS BULLETIN: REVISED Residential Support Rates to Change Effective April 1, 2013; Clarification on Back-Up Staffing Incident Reporting Procedure; Utilization Management Information: Attention ICF-IID Providers, Authorization Info for Day Treatment Providers, REVISED Medicaid and IPRS Benefit Grids, Reminders, Issues Partners BHM is aware of; REVISED Quarterly Level I Incident Report Reminder with Additional Info; Web Updates; Partners BHM Sponsored Meetings and Training--Community Guide Meeting (I/DD), Day Treatment UM Technical Assistance Training, NC TOPPS Training, Critical Case Conference, ASAM Training, NC Implementation of USDOJ Settlement Agreement Supportive Employment Consultation Meeting
In this Bulletin: From Provider Network Management--Attention Providers—Do you have your current licensure information on file?; Partners Provider Council Meeting: Finance and Claims Information--Standardized Check Write Schedule, Diagnostic Coding Tips for Billing, Claims Denial Review Process, Remittance Advice, Reminder about Principal Diagnosis, TIPS for submitting Level II-IV Residential Claims, THERAPEUTIC LEAVE (0183) for MEDICAID BILLABLE SERVICES, Advanced Payments, Tips for working denials; Utilization Management Information--CORRECTION-Functional Behavioral Assessments and Behavioral Intervention Plans, CPT codes 90791 and 90792 (Psychiatric Evaluation); Intellectual/Developmental Disabilities and NC Innovations--Relative/Legal Guardian as Provider Process, List of Community Guide and Agency with Choice Providers, NC Innovations Category on Partners BHM Website; Partners Wants You to Know--We Want Your Feedback (survey), Building capacity for NC Certified Peer Support Specialists, ASAM Training , NC Implementation of USDOJ Settlement Agreement Supportive Employment Consultation Meeting;
State News--Medicaid Special Bulletin, NCTracks Newsletter Available
(Published May 1, 2013) IN THIS BULLETIN: From Provider Network Management--Provider Monitoring, May Partners Provider Forum, Do you have your current licensure information on file? Finance and Claims Information--Standardized Check Write Schedule; Utilization Management Information--Attention Day Treatment Providers, CPT Code 90785, Benefit Grids; Partners Wants You to Know--Memo to Hospitals and Mobile Crisis Providers regarding Mobile Crisis Teams and the Redesign of the Mobile Crisis Services, Consumer Explanation of Benefit Questionnaires, Reminder to ACT Teams from the Division of MH/DD/SAS; State News--Communication Bulletin #131, Western Highlands Network and Smoky Mountain Center Announce Plans
REVISED Outpatient Treatment Plans article on May 31, 2013.
Posted May 30, 2013. IN THIS BULLETIN: MEMO--From the Desk of the Medical Director; Partners BHM Network Community Guide and Agency With Choice Providers; Relative/Legal Guardian as Provider Process; Provider Network Management--June Partners Provider Forum, Notice To IPRS Providers, May Provider Forum, Do you have your current licensure information on file? Finance and Claims--Position Announcement, Proposed Fiscal Year 2013-14 Budget; Utilization Management--Psychological Testing, IPRS-Funded Day Treatment, Retroactive Medicaid, Partial Hospitalization, Psychiatric Residential Treatment Facility, Outpatient Add-On Codes, Comprehensive Clinical Assessments, Outpatient Treatment Plans, IPRS and Medicaid-Funded Psychosocial Rehabilitation Services, Person Centered Plans for IPRS and Medicaid-Funded Services, Theraputic Leave Group Living-Adults, Therapeutic Foster Care Concurrent Authorizations, Benefit Grids; Partners Wants You to Know--Web Updates, Catawba County Care Reviews, Cleveland, Gaston and Lincoln Adult Collaboratives, DATE CHANGE--Wellness Recovery Action Planning; State News--Division of MH/DD/SAS Director Announced, NC Tracks News
Finance and Claims
• Position Announcement
• Proposed Fiscal Year 2013-14 Budget
(Posted June 14, 2013) In this Bulletin: Transitions to Community Living Initiative; Consumer Eligibility; Provider Network Management--June Provider Council Meeting, Position Announcement, June Provider Forum Handouts;
Customer Services/Access to Care--Special Project Enrollment Forms, Enrollment Requests, The Slot Scheduler - Scheduling Appointments, Update Requests, Target Population; Utilization Management-REVISED May 31, 2013--Outpatient Treatment Plans; IPRS and Medicaid Funded Psychosocial Rehabilitation Services; Person Centered Plans for IPRS and Medicaid Funded Services, Therapeutic Foster Care, Associate Licensed Clinicians, Benefit Grids; Finance and Claims--IPRS/State-Funded Claims Cutoff Dates, Taxonomies to be utilized when submitting claims to Partners; Partners Wants You to Know--What Are Your Training Needs? New Fax Numbers for Partners BHM Staff, June Enrollee Education Sessions, Partners BHM Global Continuous Quality Improvement Committee, Psychiatric Residential Treatment Facility Training, Supported Employment Basic Training & Mentoring Series.
IN THIS ISSUE:
Partners BHM Contact Information
Alpha MCS Information and Training
Authorization for Use, Disclosure, and Exchange of Protected Health Information
Medicaid Pass-Through Billing
Provider Dispute Form
Reminder-Electronic Funds Transfer Participation
IN THIS ISSUE: Network Enrollment Applications; Trying to contact Partners BHM?; Authorization Requests Calls to Access to Care by persons with Private Insurance; Calls to Access to Care by persons with Medicare; Mobile Crisis Scheduling; State Funded (IPRS) Sliding Fee Scale; NCTOPPS; New Compliance Program; Level I Incident Reports;
Alpha MCS Updates
Partners BHM Provider Manual Update
IN THIS ISSUE: A Word from Rhett Melton, Partners CEO; Partners Check Write Schedule; Partners Trading Partner Agreement; Partners 837 Companion Document; Alpha MCS Provider Files; SARS and the Benefit Plan;
Alpha MCS Scheduler Enhancements; Claims Processing; Additional Alpha MCS Provider Trainings Available; Provider Credentialing and Enrollment; Authorization for Use, Disclosure, and Exchange of Protected Health Information.
IN THIS ISSUE: DON’T FORGET TO SUBMIT YOUR APPLICATION!
Information regarding consumers with Medicare/Private Insurance; NC TOPPS Submissions; Provider Specialist Assignment List; Alpha MCS Questions and Answers; Partners Provider Council; Upcoming Provider Trainings and Events
IN THIS ISSUE: Information for Providers who have not applied for the Partners BHM Network, Consumer Enrollment Process, Provider Orientation Toolkit, Service Authorization Request for Enhanced Services, AlphaMCS Information,
Care Reviews, Mental Health/Substance Abuse Targeted Case Mgmt. Transition Team Meeting, Provider Forums,
Intellectual/Developmental Disabilities Community Education Forums, Partners Provider Council, Child Collaborative Meeting Time Changes
IN THIS BULLETIN: Billing by Associate Licensed Professionals, Check your AlphaMCS Provider Profile!; Medicaid Authorization Requests (REVISED on Jan. 24), Letter to Medicaid Recipients Regarding 1915 (b)/(c) Waiver, Provider Quarterly Incident Reports, Partners BHM Checkwrite Schedule, Special Medicaid Bulletins, CPT Conversion and AlphaMCS,
Training Dates, January Provider Forums, Previous Items Referenced in Coffee Break.
IN THIS BULLETIN: General Information (February Provider Forums, AlphaMCS Online Training, AlphaMCS Alerts, Letter to Medicaid Recipients Regarding 1915 (b)/(c) Waiver, Partners BHM’s Rates for NC Innovations—Services and Supplies, Provider Agencies selected for “Community Guide” and “Agency with Choice” Services); Contracting with Partners BHM; Information about Authorizations/Utilization Management (Documentation requirements for a SAR to be processed, Medicaid Authorization Requests, Transfer of authorizations from Value Options to Partners BHM, Initial Authorizations versus Concurrent Authorizations, Medicaid Psychiatric Inpatient Authorization Process, Authorizations for Enrollees transitioning from CAP-MR/DD Waiver to NC Innovations Waiver); Care Coordination Transition; State Information (Implementation Update #100; Special Medicaid Bulletins)
Partners UM Fax Number Modified on Feb. 12, 2013.
IN THIS BULLETIN: Enrollee Education Sessions; AlphaMCS Information (Log In Requests, Training); Information about Authorizations/Utilization Management (Outpatient Behavioral Health Therapy--Unmanaged Visits; ICF-IID Authorizations, Authorizations for Residential Level III and IV); Claims and Billing (Claims Processing, Billing by Associate-Licensed Professionals, “Incident To” Billing and Outpatient Behavioral Health Services by Psychiatric Nurse Practitioners and Physician Assistants, 837 Submissions)
Posted and REVISED April 5, 2013. IN THIS BULLETIN--April Provider Forum Change, Attention IPRS (State-Funded) Providers—Agreement Renewal, Additional Check Write, AlphaMCS Claims Guide; Utilization Management Information--Expedited Reviews, Documentation Reminder for Residential Level III, IV or PRTF, Day Treatment Service Definition, Benefit Grids; Partners BHM Sponsored Meetings and Training--An Introduction to Child and Family Teams: A Cross System Training from the Family’s Perspective, NC TOPPS Training, Critical Case Conference, ASAM, NC Implementation of USDOJ Settlement Agreement Supportive Employment Consultation Meeting. State News--Communication Bulletin #129, Special training for the Medicaid NC Tracks System
Please read this if you are providing Behavioral Health Services to Medicaid currently have a contract with Crossroads Behavioral Healthcare, Mental Health Partners or Pathways Local Management Entities (LMEs).
Questions and answers about the provider enrollment and credentialing process. This document was updated September 24, 2012.
Posted Feb. 18, 2013. Didn't have a chance to attend a Provider Forum? Click above to read the minutes and obtain copies of handouts.
(Posted June 14, 2013). Links to handouts from the forum.
Posted Mar. 18, 2013. Didn't have a chance to attend a Provider Forum? Click above to read the minutes and obtain copies of handouts.
(Posted May 20, 2013) Handouts from the May 14 Provider Forum. Includes housing and corporate compliance information.
(Posted May 13, 2013)
Revised April 15, 2013. Effective with the Checkwrite Cycle cutoff date of May 14, 2013, Partners BHM will implement the standardized MCO Checkwrite schedule. This document outlines the cutoff dates for claims submission and payment dates through the end of 2013.
As of April 15, you must submit a Claims Denial Review Form in order to have claims reviewed by Partners. This form is part of the formal process to request claims denials reviews. Instructions are available on the form.
Posted January 30, 2013
The Partners BHM Provider Operations Manual includes operational information for doing business with Partners BHM. Providers are recommended to review the Provider Communication Bulletins for operational changes.
Revised on February 27, 2013. This form is used to establish Electronic Funds Transfer with Partners BHM.
New to the Partners BHM network? The Provider Orientation Toolkit lists descriptions and quick links to some of the documents that you need to be familiar with.
(updated May 2, 2013) Do you work in a Provider Agency that is part of the Partners BHM Network? If so, your provider specialist is here to assist in navigating business in a managed care environment. Simply find your agency name on the list to identify the specialist assigned to you.
(updated May 2, 2013) Are you a Licensed Independent Practitioner in the Partners BHM Network? If so, your provider specialist is here to assist in navigating business in a managed care environment. Simply find your agency name on the list to identify the specialist assigned to you.
Posted March 18, 2013. This information is for providers serving NC Innovations participants.
Residential Providers who currently have a Contract or Memorandum of Agreement with the LME-MCO are required to complete the Initial Residential Facility Information Form the first time they are submitting information in regards to their residential facility.
Once an Initial Residential Facility Information form has been submitted, Providers are required to submit Weekly Residential Facility Information forms per the schedule listed on page 2 of this document.
(Posted June 14, 2013) Need to send an secure, encrypted email to Partners BHM? Learn how with this document.
(Posted May 20, 2013) ASAM scores are required on Service Authorization Requests (SARs) for anyone with a substance abuse diagnosis or receiving substance abuse services. This document outlines information needed for scoring adults.
(Posted May 20, 2013) ASAM scores are required on Service Authorization Requests (SARs) for anyone with a substance abuse diagnosis or receiving substance abuse services. Utilization Management currently does not mandate the use of this form, but forms may be requested from providers if specific information is needed regarding how scores were obtained.
(Posted May 20, 2013) This document will assist Providers using the CALOCUS tool. Use of form is not mandated by Partners BHM. Utilization Management does recommend that Providers attach the scoring sheet with a Service Authorization Request to support submitted CALOCUS scores.
Slides from the March 26, 2013 training for service providers offering Day Treatment.
Revised April 15, 2013 to correct information about need to conduct the FBA/BIP . This assessment should be completed and submitted anytime the parent or school staff see a pattern or major problem with the student’s inappropriate behaviors.
Posted Feb. 28, 2013. This document details the requirments for authorization of ICF-IID services. Providers should also reference the UB04 Instructional Guide for claims details.
(Posted Feb. 4, 2013) This form is to be used for prior approval and utilization review of ICF-IIDLevel of Care.
(Posted May 20, 2013) This document will assist Providers using the LOCUS tool. Use of form is not mandated by Partners BHM. Utilization Management does recommend that Providers attach the scoring sheet with a Service Authorization Request to support submitted LOCUS scores.
(Posted June 14, 2013) Partners BHM has posted this form to be used for two situations:
The Alpha MCS system is not available and is not expected to be available for an extended period of time; for example; 8 hours or more. This information will be communicated via the Partners BHM website.
A provider is an out-of network and/or out-of-area provider who is serving a Partners BHM consumer who either requires specialty treatment not available in the network, is out of the catchment area when a crisis occurs or lives in another catchment area but Medicaid is not expected to change. Examples of living outside the Partners BHM catchment area with Medicaid from one of Partners BHM counties are children who were adopted and their Medicaid will always continue to be from one of our eight counties and consumers who are living in residential situations in another area.
(Posted Feb. 4, 2013) This form is used to assess medical treatment for ICF-IID level of care.
Posted February 22, 2013. Form to be used for Psychological Testing authorization request.
(Posted February 22, 2013) Information and direstions for requesting authorization for Psychological Testing.
Posted Feb. 13, 2013. This presentation identifies how, when and what is needed to obtain an authorization through Partners BHM.