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Frequently Asked Questions for Providers

County Realignment

Cabarrus, Union and Stanly County Boards of County Commissioners have passed resolutions to disengage from Cardinal Innovations Healthcare and align with Partners. Each of the three counties have submitted their requests to realign to the Secretary of North Carolina Department of Health and Human Services.

Forsyth County’s Board of County Commissioners voted on March 4 to begin the process for realignment. To review the plan, visit https://forsyth.cc/disengagementplan.aspx.

Counties that request to realign with a different local management entity/managed care organization (LME/MCO) must submit their request and disengagement plan for approval of the Secretary of the North Carolina Department of Health and Human Services (NC DHHS). For information on the county disengagement process, go to:
https://ncdhhs.gov/divisions/mhddsas/lme-mcos

 

Providers that serve citizens in realigning counties who have Medicaid or have no health insurance, and who receive Mental Health, Substance Use Disorder or Intellectual and Developmental Disabilities services may be impacted if the realignment is approved. 

Yes. Partners will work with providers currently serving realigning counties to include them in Partners’ Provider Network. Partners will honor member service authorizations, annual plans and other documentation and decisions essential to ensure a smooth transition. 

Partners has a philosophy of a broad provider network, ensuring choice and access for members in the county. Though LME/MCOs are permitted to have a “closed network”, Partners has never limited provider enrollment in that way. We welcome all providers who are in good standing with state minimum qualifications and will not limit entry to the network based on size of the providers or the continuum of services offered. 

Partners will honor all rates in place on May 15, 2021. Providers will continue to be paid these rates after the transition to Partners. If Partners rate is a higher rate, Partners will work with DHHS to create the opportunity to provide the higher rate to current providers.

 

Yes, please complete the online Request for Consideration Form. We will then collect your information and work with you to complete that process now, understanding that Partners would not be responsible for member coverage in those impacted counties until the County Realignment is approved the Secretary of North Carolina Department of Health and Human Services. 

Yes, please complete the online Request for Consideration Form. We will then collect your information and work with you to complete that process now, understanding that Partners would not be responsible for member coverage in those impacted counties until the County Realignment is approved the Secretary of North Carolina Department of Health and Human Services. 

Yes. Please use the Provider Change Form to add all sites/services/clinicians serving members from these counties. We will then collect your information and work with you to complete that process now, understanding that Partners would not be responsible for member coverage in those impacted counties until the County Realignment is approved by DHHS. 

Yes. Once the Request for Consideration has been processed you should receive a link to the credentialing application to start the process of being credentialed with us. If you have questions about the status of your request to join please contact us at PAS@partnersbhm.org. If you have already received the link to the credentialing application please follow the instructions for completing the process or contact us at credentialingteam@partnersbhm.org for a status update. 

This process requires that you receive a letter of support from the entity that is currently responsible for the county. You would need to receive the Letter of Support from Cardinal until the County Realignment has been approved by DHHS. Partners would provide the Letter of Support after the official date of realignment. 

Partners is committed to continuity for members as part of county realignment. Services that are not currently in Partners benefit grid, such as specialty or In Lieu Of services, will be addressed once we have approval for the county realignment. 

Partners is committed to member/provider continuity and provider stability. We are collaborating with Cardinal to collect this information and assure contracts align. 

Partners’ financial intermediary agency for EORs is Acumen. Cardinal uses Acumen, as well.

Cardinal and Partners understand the importance of seamless transition for individuals who are in mid-process getting on the Registry of Unmet Needs during the transition. Cardinal will provide information about those individuals to Partners and Partners will reach out to the individual to discuss current status and next steps.  Feel free to send any specific questions to Tammy Gilmore at tgilmore@partnersbhm.org.  

A member’s services will continue during this process. Service authorizations for Partners will start on Sept. 1,2021. Our goal is to enter data in a 30-day timeframe, as we will not receive the information prior to Sept. 1. However, member services will continue without interruption.

Turnaround time is usually 8 to 9 days from claim submission to paymentProviders must ensure that they are set up in our claims system before the date of realignment.  

Yes. All current Cardinal members who are residents of CabarrusUnion and Stanly counties will transition to Partners on Sept. 12021.

LME/MCOs are not using the EVV system yet. Partners is working with HHA Exchange and LME/MCO colleagues on the EVV system and process. Please visit https://providers.partnersbhm.org/electronic-visit-verification/ for the most up-to-date information regarding EVV.  

Partners is tracking the flexibilities through the provider submission. We will further discuss AppendixK flexibility reporting in a future meeting for Innovations providers.

Prior to Sept. 1, 2021 authorization requests should be sent to Cardinal. As of Sept. 1, authorization requests will need to be submitted to Partners. Typically, services are requested 14 days prior. However, if the system will not allow this, the provider needs to request the service on Sept.1. We will use the prior authorization to inform the Sept. 1 start.   

LTCS is not the same as ACTT/Daily.  Enrollment forms are not needed for Long Term Community Supports.

SACOT information is processed through the Alpha portal.  Submit the Enrollment form data at the next visit, through AlphaMCS portal.

If the admission is an urgent/crisis nature then we do not require financial documents.

ADVP is an I/DD  periodic Daily Service.  Yes, submit the Enrollment form by fax or secure email.

September 1, 2021 please submit an Enrollment through AlphaMCS. The Alpha system will not allow any pre-dating.

If you have an active authorization as of Aug 31, you will receive an authorization from Partners for the remaining days of the current authorization.

There are 6 LME/MCOs that chose AlphaMCS. It is possible that Sandhills has developed a modification, but the basic function of AlphaMCS is anticipated to be the same.

Group Living can be authorized up to 1 year. Partners authorization guidelines can be found here: https://providers.partnersbhm.org/benefit-grids/

Call the Alpha Helpdesk:  704-842-6431.  This resource will give you the information needed for connecting to AlphaMCS and training:  https://providers.partnersbhm.org/transitioning-to-alphamcs/

We are working closely with Cardinal to create a cross walk document and will publish as soon as completed.

NC SNAP or SIS evaluation is required for (b)(3) Community Navigator.  In order to provide flexibility during this transition we encourage providers to get the NC-SNAP or SIS completed.  This will become a requirement as of Jan. 1, 2022.    

NC-SNAP scores are good for one year. A new NC-SNAP must be completed on or before the date of expiration.   

NCDHHS offers NC-SNAP training.  Attendees must register through an LME/MCO and complete forms to gain a space in a scheduled class.  Please refer to the Partners Provider Training Catalog for instructions on how to obtain NC-SNAP Certification training.  https://www.partnerstraining.org/provider-training-catalog/  

NC SNAP certification will automatically be inactivated after 21 months of inactivity (the examiner does not submit a completed assessment to the LME-MCO that is keyed into the database for 21 months). Once a NC SNAP certification is inactive, recertification is required. 

Provider agencies should have a certified NC-SNAP Examiner on staff. If your agency does not have a certified NC-SNAP Examiner on staff, Partners encourages you to work with other agencies to get NC-SNAPs completed annually as required.

Please refer to the Partners Provider Training Catalog for instructions on how to obtain NC-SNAP Certification training. https://www.partnerstraining.org/provider-training-catalog/

Please also note that DHHS has a posted 2021 NC-SNAP Virtual Training Schedule https://www.ncdhhs.gov/providers/provider-info/mental-health-development-disabilities-and-substance-abuse-services/nc-snap-nc-support-needs-assessment-profile 

In order to provide flexibility during this transition we encourage providers to get the NC-SNAP or SIS completed as soon as possible.  This will become a requirement as of Jan. 1, 2022.  Please note on the Service Authorization Request justification any issues with obtaining a NC-SNAP.  We want to collaborate with providers to ensure a seamless transition of care for the members during this time.   

The service definition requires a treatment plan. Partners will also accept a fully completed Person Centered Plan (PCP).

Once you have access to AlphaMCS, you may be able to see if a SIS has been completed. Our Assessment Team in I/DD Care Management strives to give permissions within AlphaMCS to allow all current service providers the ability to view their member’s SIS.

Partners uses monthly limits. Monthly limits start the effective date of a member’s authorization for the service.  For example, a member has an authorization for the service T2041 effective Jan 10, 2021.  Therefore, the provider can bill for the service between Jan. 10, 2021 – Feb. 9, 2021 for one unit.  The monthly limits then restart again on Feb. 10, 2021 and the provider can proceed to bill again for the service between Feb. 10, 2021 –March 9, 2021 for one unit.  The monthly limit restarts again March 10, 2021 and so on. Each billing cycle needs to have 30 days in between. 

The start date of the member’s authorization will be Sept. 1, 2021.  Each billing cycle needs to have 30 days.  The provider would bill between Sept. 1, 2021-Sept. 30, 2021 for DOS in September.  The provider does not need to render services on the date you bill.   

Only (b)(3) DI members can self-direct services through Agency with Choice or Employer of Record.   

Only (b)(3) DI members can self-direct services through Agency with Choice or Employer of Record.   

Members currently receiving (b)(3) Respite and (b)(3) Community Navigator from the same service provider will continue to receive both services from the same provider.  Any changes regarding the direction of services will be communicated individually.

Partners has not experienced concerns with this method of service delivery.  Partners monitors the quality of care provided to our members.  Member continuity of care is of great importance during this transition.

The LME/MCO is not to direct this decision.  Providers should collaborate.  It has been our experience that if an individual member is receiving Residential services, the Residential provider takes on the role of primary clinical home.

It is the expectation that providers serving the same member collaborate on the treatment plan.  If using the PCP, the plan needs to be updated according to schedule as outlined in the PCP manual.

After consultation with Partners HIPAA Privacy Officer, it has been determined Assigned Community Navigators can call the Partners Health Information Management (HIM) department to discuss which providers are serving an individual member as a matter of coordination of care.  Dial 1-877-864-1454 and press 0 to speak to the operator.  Ask for the HIM department. Note:  Substance use care will not be able to be shared without an explicit consent to release information, due to 42 CFR Part 2 not allowing an exception for coordination of care.

Yes. Partners will continue to offer (b)(3) In Home Skill Building Moderate-T2013 TF U4; High-T2013 U4. 

Individual Goods and Services is only available for members who are self-directing one or more services on the Innovations waiver  

No, (b)(3) Respite services (H0045U4HA, H0045U4HB, H0045HQU4HB, H0045HQU4HA) cannot be self-directed.  Only members receiving (b)(3) DI funding would be able to self-direct (b)(3) DI Respite (S5150U4 -individual, S5150HQU4 -group) 

Community Navigator can be authorized up to 12 units per year.   

Partners assigns each member to a staff person so that members and Legally Responsible Persons (LRPs) have a point of contact for questions.  Members receive this information by a letter sent through US Mail. 

We will request that authorized providers are given access to view the letter but please know that this may take some time, given the number of members transitioning.  

Only (b)(3) DI members can self-direct services through Agency with Choice or Employer of Record. Partners Provider Communication Bulletin #120 has additional information regarding the county realignment and service code crosswalk.  https://providers.partnersbhm.org/provider-communication-bulletin-120/#4 

To provide flexibility Partners will allow up to two annual information sessions per member per rolling calendar year.  Each session will be reimbursed at a rate of $35.

Once a provider has a contract with Partners, the provider will receive written directions of how to reach out to the IT department to gain access to AlphaMCS.  Partners cannot load member authorization information into AlphaMCS until the transition date of Sept. 1, 2021 for Cabarrus, Union or Stanly residents or Nov. 1, 2021 for Forsyth and Davie members.  We ask for provider patience while we manually load all of the authorizations as quickly as we can. The Partners Provider Knowledge Base has information for self-guided training to use AlphaMCS:  https://providers.partnersbhm.org/transitioning-to-alphamcs/  

 

We understand that Cardinal provided training materials that providers were required to use for initial training and annual training.  The state of NC has been working to align member materials for the service.  Currently Partners allowed providers the flexibility to use their own materials for training members and Legally Responsible Persons (LRPs).  Partners is working to develop materials.  Providers can supplement information on an individualized basis to meet the unique needs of the member and LRP.

Self-directing is only available for members on the Innovations waiver or receiving (b)(3) DI funding. Clinical Coverage Policy 8P Attachment H (https://medicaid.ncdhhs.gov/behavioral-health-clinical-coverage-policies) has more information regarding self-directing Innovations services.  Innovations allows a member to self-direct Community Living & Supports, Respite, Supported Employment, Community Networking, Natural Supports Education and Individual Goods & Services (in conjunction with at least one other self-directed service).

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