Eastpointe March 15, 2017 10:00am until 1:00pm Webinar
Welcome and Overview Karen Salacki Eastpointe Provider Network Council Nicole Bauer External Operations Updates Karen Salacki Program Integrity Melinda Weissinger First Commitment Waiver Tanisha Draughn
Disaster Form Reminders Relative as Provider Reminders Network Operations Updates Listserve changes Next Provider Meeting Contact Information Tanisha Draughn Becky Womble Linda Hawley Isbell Karen Salacki
Nicole Bauer
For Council Information: Go to www.eastpointe.net, then For Provider Community, the Eastpointe Provider Network Council Information Contact Information: providercouncil@eastpointe.net
The Eastpointe Provider Network Council meets the 4 th 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 Chief of External Operations
Our Provider Network is closed. This is for Medicaid and State Services. We are not adding new State contracts or adding services to State contracts. We are accepting applications for: Medicaid services for Psychiatrists in private practices. We are accepting applications from Hospitals. Agencies may also add an Outpatient Therapist. Agencies may add a Site to provide Outpatient Services.
If you are requesting to add an Outpatient Site you must follow the Add a Site process. This includes an onsite review. Please pay close attention to the changes to that process that will be discussed later in the meeting. Please remember that you cannot open a new Outpatient site or provide services at that site until you receive an approval letter from Network Operations.
If you need to add a Taxonomy Code to an approved site, please submit this request on your letterhead to networkoperations@eastpointe.net The following elements need to be included on agency letterhead: Name of Agency Date of Request Site Name that you are asking to add the taxonomy to Taxonomy Code(s) that you want to add The letter needs to be signed and dated by the CEO or designee Please add in the letter that this is a Request to add Taxonomy Codes to an approved site.
To avoid potential recoupment of funds, all providers need to validate the following items: 1. Check to make sure every Alpha site for which your agency bills, is in NC TRACKS with the correct billing NPI. 2. Check to make sure that you are registered for the correct Taxonomy Code for each procedure code at each site in NC TRACKS. 3. Check addresses including the zip + 4 to ensure they are matching in Alpha and NC TRACKS. 4. Make sure that the NPI and Taxonomy codes that are submitted on a claim match what is in NC TRACKS and Alpha MCS.
The Eastpointe Area Board has 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 transition is expected to be complete by July 1, 2017. 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.
Melinda Weissinger
Eastpointe Program Integrity will be conducting a face to face Fraud, Waste, Abuse (FWA) training to all contracted providers on the following topics: The Eastpointe PI Audit Process How to identify FWA within your agency Provider Self-Audit Process
Eastpointe Lumberton Site 450 Country Club Road Lumberton, NC April 25, 2107 from 10:00 am until 1:00 pm
Eastpointe Rocky Mount Site 500 Nash Medical Arts Mall Rocky Mount, NC 27804 April 27, 2017 from 10:00 am until 1:00 pm
Be on the look out for registration information that will be sent to the provider community via the listserve.
Tanisha Draughn, M.Ed.
In early 2000 it was determined that there was a lack of professionals legally qualified to carry out the first exam in the Involuntary Commitment process (IVC) especially in rural North Carolina. In 2003 the North Carolina General Assembly passed legislation approving a pilot project that allowed a licensed clinical social worker, a masters level psychiatric nurse, or a masters level certified clinical addictions specialist to conduct the initial (first level) examinations.
As a part of this pilot project, NASW-NC with the NC Psychological Association, the NC Psychiatric Association, the North Carolina Department of Health and Human Services (DHHS) Division of Mental Health and staff from numerous LME/MCOs developed a training and credentialing process for Licensed clinical social worker, Master s level psychiatric nurse and Master s level certified clinical addictions specialist. Effective 10/1/2011 the General Assembly gave permanent approval for LCWs, Master level psychiatric nurses and Master s level certified clinical addictions specialist to conduct the First Commitment Evaluation. (Session Law 2011-346, senate bill 437)
The General Statues also state A physician shall be available at all times to provide backup support to include consultation and face to face evaluation if needed. This substitution in no way should be construed as authorization to expand the scope of practice of the LCSW, master s level LCAS or the master s level psychiatric nurse.
Candidates identified-lcsw, LCAS and Psychiatric Nurses Forms desk form Completed and submitted The Form desk verification form can be found: www.eastpointe.net Provider/Information, Manuals & Forms/Forms First Commitment Waiver Notification Form Candidate will be approved or denied by LME-(Candidate and supervisor must be credentialed by Eastpointe MCO Supervisor must be MD, Physician, Psychologist Complete online Training and Testing Complete 3 Evaluations Candidate will be Deemed competent by their supervisor Candidate information will be sent to DHHS Certification is for 3 years
The State has collaborated with the Behavioral Healthcare Resource Program at UNC-CH School of Social Work to create a site that allows for people enroll into courses and then take the required exam.
Eastpointe will recommend the candidate after verification is complete BHRP (Behavioral Healthcare Resource Program) staff will create a username and password for the candidate and will send to them via email. This will give them access to the online training materials. BHRP will notify Eastpointe that access has been granted to the candidate. The candidate will have unlimited access to the training material.
Candidate will notify Eastpointe Network Operations Department via email networkoperations@eastpointe.net that they are ready to take exam. Eastpointe notifies BHRP and BHRP staff registers candidate for exam. Eastpointe will give candidate date and time of exam and candidate will complete exam at the Eastpointe Rocky Mount site. After candidate begins exam, they have 2 hours to complete.
If the candidate passes the exam they will 1. Complete an evaluation 2. Receive a certificate of completion that will attest that they have satisfactorily passed the civil Commitment Exam for North Carolina.
The candidate must arrange a second attempt within 60 days. Should they fail a second time, they will need to wait for ninety days before being given the opportunity to retake the test one further time and continue with the First Commitment Process. If they fail a second time, they will then wait a year from the time of the second failed passing before given the opportunity to test again.
Once the candidate passes the exam they will complete 3 or more evaluations under the supervision of the identified supervisor.
networkoperations@eastpointe.net & mark.odonnell@dhhs.nc.gov The statement must indicate the supervisors determination of the candidate s competence.
Once the Division has received the signed statement, the Division s Master List will be updated. An ID card will be generated for the candidate by Behavioral Healthcare Resource Program UNC-CH School of Social work and sent to Eastpointe for distribution.
First Commitment evaluations that deem the individual being examined as fit to be returned to the community require the First Commitment evaluator to call the supervising eligible psychologist or psychiatrist prior to the release. This is a safety check meant to safeguard the individual, evaluator and the supervisor.
Tanisha Draughn, M.Ed.
As we are all aware, the storm Hurricane Matthew impacted our Eastpointe provider network and members tremendously. During Hurricane Matthew, our Community Relations Department utilized the information received from the Disaster Shelter forms to reach out to providers and ensure the safety of our members. As a result, Eastpointe is reminding all providers to submit and/or update their Disaster Plan and Shelter Forms.
The Disaster Plans and Disaster Shelter Forms are required and were to be submitted upon the renewal of your 2016-2017 IPRS contracts. If your Disaster Plans and Disaster Shelter Forms have not been submitted, please send updated copies of your plan and shelter form to Network Operations via fax or email.
The updated Provider Participant for Disaster Shelter Form has been updated to include additional elements: Date form completed Indication of the counties where your sites are located. Signature of person completing form
The Disaster Shelter Forms are required and were to be submitted upon the renewal of your 2016-2017 Medicaid contracts. If your agency's Disaster Shelter Forms have not been submitted, please send updated copies of the form to Network Operations via fax or email.
A Disaster Plan Template is available as an example, but it is not mandatory to use this template. To locate the template, go to www.eastpointe.net, Provider > Manuals and Forms > Forms> Disaster Forms The Eastpointe Provider Participants for Disaster Shelter form is also located under Disaster Forms.
Both documents can be submitted via fax or email. The fax number is 252-407-2450 and email address is networkoperations@eastpointe.net.
Employment of Relatives/Legal Guardian as Providers Becky Womble, BS/QP/CI Provider Relations Specialist Network Operations
We are only accepting the current Verification of Relative Legal Guardian as Direct Support Employee (RDSE) Application RDSE Applications are only required for requested hours of over 40 hours/week, not to exceed 56 hours/week. (This includes both Primary and back-up combined.) Remember to submit RDSE Applications only for the Relative/Legal Guardian (Prospective Employee) who live in the same home as the member.
Ensure that all boxes are checked and all applicable questions are thoroughly answered. The Annual recertification section on 2 nd page only needs to be completed if Annual Recertification is checked on 1 st first page. The Relative as Provider Innovations Waiver Daily Schedule is required with all submissions
All RDSE Applications need to be mailed or hand delivered to Eastpointe- Network Operations 500 Nash Medical Arts Mall, Rocky Mount, NC 27804 2 nd or 3 rd submissions of RDSE Applications have up to 10 business days to be mailed or hand delivered from the date on the Unable To Process (UTP) letter. All RDSE forms are located on our website as follows: www.eastpointe.net > Provider > Manuals and Forms > Forms > Relative As Provider.
Linda Hawley Isbell
It is your responsibility as a contracted provider to submit your Re- Credentialing application for yourself and for any performing providers. Please do not wait a week or so before the Credentialing expiration date to submit the application. This will cause a lapse in your Credentialing. Eastpointe sent out a courtesy letter 60 days prior to the expiration of your Credentialing. This is only a reminder. If you have received that letter you need to immediately submit your application to ensure that there is not a gap in your Credentialing.
If your Re-Credentialing is not completed prior to your Credentialing end date you will be end dated in Alpha and can no longer serve Eastpointe members. If you have any questions please contact Network Operations.
If there is a member who needs a specific Medicaid or state funded service for a specific period of time and there is not a provider in the network available to provide the needed service a Single Case Agreement (SCA) can be requested.
The new Single Case Agreement (SCA) form is submitted by the provider along with: The Electronic Funds Transfer Form (EFT), Trading Partner Agreement (TPA) Current Copies of Certificates of Insurance (COI) Copy of W-9 Copy of voided check or an official letter from the bank providing the account and routing numbers and A paper TAR if the requested service must be authorized. Copies of required licenses
Application is available in two formats: printable and web submission. Downloadable format www.eastpointe.net Provider Manuals and Forms Forms Single Case Agreement. This format should be submitted via fax to 252-407-2450 or via secure email to networkoperations@eastpointe.net.
Electronic submission format: www.eastpointe.net Provider Manuals and Forms Electronic Forms Single Case Agreement. When using this format, the required documents listed under Attachment B should be uploaded to the application under the section provided for additional documents.
These documents are available on the Eastpointe website at www.eastpointe.net Provider Manuals and Forms Forms. You should be able to save them to your desktop and once complete, they can be attached to both the Downloadable and/or Electronic Form. they can be attached to the formdesk form. them to your desktop and once complete, they can be attached to the formdesk form.
Medical necessity must be determined for services requiring pre-authorization before the SCA can be approved. Members should not be placed in a residential facility or receive services until the Single Case Agreement is approved. Provider will not receive payment for services until the SCA is approved and set up in Alpha.
This application is used to request both Medicaid and IPRS funded services. All questions on the application must be answered. Only submit for one member per application. Multiple services can be requested on the same application. Both the service and service code must be provided. Funding Source: Be sure to indicate if the requested service is for Medicaid or IPRS Funding.
SCA PROCESS Date: actual date the application is submitted to Eastpointe. Provider information on the application should be the same as the provider information in NC Tracks or the application will be determined Unable to Process (UTP). Required attachments (Section 10) must be submitted along with SCA. Zip codes require both the zip code and the plus 4.
Certificate of Insurance (COI) must be current. Provider is responsible for sending updated COI to Eastpointe. Insurance requirements are listed on the application under #5 of the terms of the executed Single Case Agreement. All applications require an original signature and signature date to prevent being determined Unable to Process. Incomplete applications cannot be processed.
Eastpointe can upload changes to NC TRACKS to add: 1. NPI 2. Taxonomy codes 3. Sites 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 networkoperations@eastpointe.net 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 networkoperations@eastpointe.net Please 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)
Provider reported issues will be documented on the NC TRACKS Issues log The NC TRACKS Issues log will be sent to the Division of Medical Assistance (DMA)every other week for review.
NC Medicaid Electronic Health Record Incentive Program Announcement. NCTRACKS Provider Training Available in February 2017 Re-Credentialing Due Dates for Calendar Year 2017 Affordable Care Act Fee Increase for Provider Enrollment Upload Documents in NCTracks Provider Portal
Upload Documents in NCTRACKS Provider Portal Medicaid and NC Health Choice Provider Fingerprint-based Criminal Background Checks
All Mental Health/Substance Abuse Providers (MH/SA) who provide enhanced services and basic benefit services and all Intellectual and Developmental Disability (IDD) Providers that provide assessments are required to maintain appointments on the Slot Scheduler. This includes Licensed Independent Practitioners (LIP) who have an LIP contract with Eastpointe.
The timeframe for follow-up completion depends on the triage and are as followed: Routine: within 24 hours of the scheduled appointment Example: If a routine appt is scheduled for August 1 st at 3:30pm, the followup is due no later than 3:30pm on August 2 nd. Urgent: by the end of the business day of the appointment date Example: If an urgent appt is scheduled for August 10 th at 3:30pm, the followup is due prior to provider closing on August 10 th.
Follow-up for any Saturday appointments should be completed no later than 9:00am on the following Monday. Example: If an appt is scheduled for Saturday, January 21st, the follow-up is due no later than 9:00am on Monday, January 23rd. If you have any questions about this process, you can reference the recorded webinar trainings completed by Network Operation and Member Call Center on the website www.eastpointe.net
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.
We are very interested in hearing from our Provider Community about topics that you would like us to discuss at upcoming meetings. We would like to make sure that we are covering topics of interest to our Provider Network. Please send those to networkoperations@eastpointe.net. Please indicate in the subject line : Provider Meeting Topics
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 April 19, 2017 from 10:00am until 1:00pm and this meeting will be a webinar.
Please contact Network Operations Call Center at (888) 977-2160 or networkoperations@eastpointe.net Fax: 252-407-2450
Member Call Center 800-913-6109 Fax: (910) 345-8971
Visit our website www.eastpointe.net to locate Communication Bulletins Manuals Provider Meeting PowerPoint s Provider Forms Training Announcements and Sign Up Provider Choice Database And so much more