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Eastpointe April Provider Meeting

Eastpointe April Provider Meeting. Eastpointe April 20, 2016 10:00am until 1:00pm Webinar. Agenda. Welcome and Overview Karen Salacki Eastpointe Provider Network Council Council Representative External Operations Updates Karen Salacki

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Eastpointe April Provider Meeting

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  1. Eastpointe April Provider Meeting Eastpointe April 20, 2016 10:00am until 1:00pm Webinar

  2. Agenda Welcome and Overview Karen Salacki Eastpointe Provider Network Council Council Representative External Operations Updates Karen Salacki National Accreditation Monica Adams

  3. Agenda (cont.) IPRS and Medicaid Contracts Dennis Murphy NO Call Center Updates Melanie Weatherford Sex Offender Specific Evaluation Jessica Plummer Disaster Plans and Shelter Forms Good Standing Becky Womble Add a Site/Move a Site Chauncey Dameron

  4. Agenda (cont.) Network Operations Updates Linda Hawley Isbell End Dating LIP’s in Alpha Provider Choice Database Specialties Provider Meeting Topics Listserve Next Provider Meeting Karen Salacki

  5. Welcome and Overview

  6. Eastpointe Provider Network Council Eastpointe Provider Network Council Representative

  7. Eastpointe Provider Network Council • For Council Information: Go to www.eastpointe.net, then For Provider Community, the Eastpointe Provider Network Council Information • Contact Information: providercouncil@eastpointe.net

  8. External Operations Updates Karen Salacki, Chief of External Operations

  9. Eastpointe’s Provider Network • Our Provider Network is closed for Medicaid and IPRS. • We are only accepting applications for Medicaid services for Psychiatrists in private practice and Hospitals. Agencies may add an Outpatient Therapist. • For further clarification please contact Network Operations.

  10. Eastpointe Provider Network • If you are requesting to add an Outpatient Site you must follow the Add a Site process. • Please remember that you cannot open a new Outpatient site until you receive an approval letter from Network Operations. • Please remember that an Licensed Independent Practitioner (LIP) cannot provide services to an Eastpointe member until they have been Credentialed.

  11. Request For Information (RFI) and Request For Proposal (RFP)Updates

  12. RFI and RFP Updates • RFI for Substance Abuse Services in Nash County. • RFP for Residential Level III Services- one home for males and one home for females in our catchment area.

  13. Acquisitions and Mergers

  14. Acquisitions and Mergers • This is a reminder that any Acquisition or Merger that a provider(s) intends to pursue must have prior approval from Eastpointe. • Please note that there are many variables to consider including capacity, Good Standing and whether one of the providers involved is not a member of our provider network.

  15. NCTRACKS Re-Credentialing

  16. NCTRACKS Re-Credentialing • All providers who have a contract and all performing providers who work for agency’s for whom Eastpointe reimburses State and/or Medicaid funds must be correctly registered and credentialed/re-credentialed with NCTRACKS. • You will receive a letter from NCTRACKS secure Message Center Inbox on the Provider Portal about Re-credentialing.

  17. NCTRACKS Re-Credentialing (cont.) • Please note that if the provider does not complete the process within the allotted 45 days, the provider record will be suspended until the re-credentialing application or Manage Change Request (MCR) has been submitted. • Suspension of a provider record will occur in NCTRACKS system at this time and has the potential of impacting Eastpointe encounter claims.

  18. NCTRACKS Re-Credentialing (cont.) • Please see the April 2016 Medicaid Bulletin and the Eastpointe Communication Bulletin #35 dated April 14, 2016 for more information about possible suspensions.

  19. Local and State Updates

  20. National Accreditation Monica Adams

  21. National Accreditation • All providers enrolled in Eastpointe’s Provider Network and providing services on or after July 1, 2008, which required national accreditation, were required to complete all accreditation requirements and be awarded national accreditation within one year of enrollment in the Medicaid program or within two years following the provider’s first contract to deliver a State-funded service requiring national accreditation.

  22. National accreditation applies to accreditation by an entity approved by the Secretary that accredits mental health, developmental disabilities, and substance abuse services. If you are not certain if accreditation applies to your agency please refer to the service definitions for the services that you provide. The service definitions will specify if accreditation is required.

  23. Benchmarks • If a provider’s Medicaid enrollment or service delivery contracts are terminated as a result of failure to meet accreditation benchmarks or failure to continue to be nationally accredited, the provider will work with the MCO to transition members served by the provider to other service providers in an orderly fashion within 60 days of notification by the MCO of such failure. • A provider that has its Medicaid enrollment or service delivery contracts terminated as a result of failure to meet accreditation benchmarks or failure to continue to be nationally accredited may not reapply for enrollment in the Medicaid program or enter into new service delivery contracts for at least one year following enrollment or contract termination.

  24. If you have questions pertaining to National Accreditation please contact Eastpointe Network Operations Call Center at (888) 977-2160. Submit required information to:Eastpointe500 Medical Arts Mall Rocky Mount, NC 27804 Attn: Monica Adams, Provider Relations Specialistvia fax (252) 407-2450 or email networkoperations@eastpointe.net

  25. IPRS and Medicaid Contracts Dennis Murphy, MBA, CGCIO

  26. IPRS and Medicaid Contracts • The State has just issued a new contract format which will be used for both State and Medicaid contracts.  • We are working on getting the template setup so we can issue using the new contract from the State. • We hope to have them ready at the beginning of May and they will cover the period 7/1/2016-6/30/2017. • All contracts will be sent out using DocuSign.

  27. Network Operations Call Center Updates Melanie Weatherford, Network Operations Call Center Supervisor

  28. Trading Partner Agreement (TPA) • These slides are intended for physician groups and hospitals that bill Eastpointe for Emergency Room Claims. • The Trading Partner Agreement is required as part of the documentation needed for Eastpointe to set up the provider in the system if billing via 837. • The TPA constitutes an agreement for Electronic Data Interchange (EDI) between the Trading Partner listed and Eastpointe.

  29. Trading Partner Agreement (TPA) • The transaction sets are part of the Trading Partner Agreement and should be initialed and checked if relevant for your physician group or hospital. • Please also indicate on the TPA if there is a billing agent or clearinghouse that is being used by a physician group or hospital. • If your agency is not billing via 837, please indicate the billing agent and clearinghouse on the Emergency Department Set Up Form.

  30. Trading Partner Agreement (TPA) • Please note that if there is not a billing agent or clearinghouse listed on the TPA or Emergency Department Set Up Form, information will not be relayed to any group if they contact Network Operations unless we have written permission from the physician group or hospital that we have an agreement with.

  31. Quarterly Statistics for Network Operations Call Center • Network Operations received 4,817 calls during the January – March 2016 Third Quarter.

  32. Sex Offender Evaluation and Treatment Jessica Plummer, MA

  33. Certification • Sex Offender Treatment is a service that can only be provided by clinicians that have specific training and certification. • The clinician must be a Certified Sex Offender Treatment Specialist (COSTS) or a Clinically Certified Sex Offender Treatment Specialist (CCSOTS) in order to provide sex offender evaluations and treatment.

  34. Sex Offender Treatment Services Form • If you have a clinician that is either a COSTS or a CCSOTS and you would like to provide services to these members, you must submit their information to Eastpointe using the Sex Offender Treatment Services Form. • We will also need a copy of their current certificate, showing an active certification. • The Sex Offender Treatment Services Form is available on the Eastpointe website, located under Provider Forms and can be submitted to Network Operations via email or fax.

  35. Specialty Services • We are reviewing the Specialty Services selected by agencies on the Provider Change Form to determine which agencies reported the ability to provide Sex Offender Treatment • If we do not have record of a clinician with a COSTS or CCSOTS certification at your agency, we will remove this specialty from you agency.

  36. Disaster Plans and Provider Participants for Disaster Shelter Forms

  37. Reminder… • As you are aware, Eastpointe began the use of DocuSign to expedite the contract process. This is a reminder of the contract requirements regarding Disaster Plans and Eastpointe Participants for Disaster Shelter Forms. • These documents are necessary to ensure the safety of our members in the event of a disaster.

  38. IPRS Contracted Providers • The Disaster Plans and Disaster Shelter Forms are required and were to be submitted upon the renewal of your 2015-2016 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.

  39. Medicaid Contracted Providers • 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.

  40. More info… • 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, For Provider Community, and then click on Provider Forms. • The Eastpointe Provider Participants for Disaster Shelter form is also located under Provider Forms.

  41. Fax Number and Email Address • Both documents can be submitted via fax or email. • The fax number is 252-407-2450 and email address is networkoperations@eastpointe.net.

  42. Verification of Good Standing Becky Womble, BS, QP NCI Provider Relations Specialist

  43. Verification of Good Standing Requests for Good Standing are needed in the following instances: • Adding a provider site and moving a provider site • Requests for Information (RFI) • Requests for Proposal (RFP)

  44. Verification of Good Standing Internal Review is conducted in conjunction with the following Eastpointe Departments: • Program Integrity • Program Monitoring • Grievance and Appeals • Quality Management (NC-TOPPS) • Network Operations - Accreditation • Network Operations - Certificate of Insurance

  45. Verification of Good Standing Potential Outcomes that affect Good Standing: • Plans of Correction • Recoupment status • Complaints • NC-TOPPS • Accreditation • Insurance

  46. Verification of Good Standing Outcomes: If Not in Good Standing, the process for review will cease. Eastpointe will send provider a letter to notify them that they have not been approved to add/move a site or be awarded an RFI or RFP. If interested in knowing the reason for the Not Good Standing status, provider will need to submit a letter on their agency letterhead signed by director or designee requesting the reason for Not in Good Standing status.

  47. Adding a Provider Site and Moving a Provider Site Chauncey Dameron, BS

  48. Adding a Provider Site and Moving a Provider Site Location Policy • Eastpointe Local Management Entity /Managed Care Organization’s (LME/MCO) providers must receive written prior approval from Eastpointe before moving a current Contracted site to a new location or adding a site to their current contract.

  49. Adding A Site • This process occurs when a provider is approved to add a site to their current contract • Eastpointe currently has a closed Provider Network, but has approved for providers to request to add an Outpatient Therapy Site ONLY

  50. Adding A Site Procedure • Provider must submit a signed letter from CEO or designee on agency letterhead requesting to add a new site location to their contract. Letter must be submitted to Network Operations via email or fax. • Letter must include: • Address of new site • Service(s) that will be provided, including service code(s) • NPI number of the new site

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