Eastpointe April Provider Meeting Eastpointe April 20 2016

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

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

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

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

Welcome and Overview

Eastpointe Provider Network Council Representative

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

External Operations Updates Karen Salacki, Chief of External Operations

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.

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.

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

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.

Acquisitions and Mergers

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.

NCTRACKS Re-Credentialing

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.

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.

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.

Local and State Updates

National Accreditation Monica Adams

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.

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.

networkoperations@eastpointe. net

IPRS and Medicaid Contracts Dennis Murphy, MBA, CGCIO

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 Docu. Sign.

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

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.

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.

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.

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

Sex Offender Evaluation and Treatment Jessica Plummer, MA

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.

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.

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.

Disaster Plans and Provider Participants for Disaster Shelter Forms

Reminder… As you are aware, Eastpointe began the use of Docu. Sign 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.

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.

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.

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.

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.

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

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)

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

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

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.

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

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.

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

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

Moving A Site This process occurs when a provider is approved to move a site that is part of their current contract from one location to another location.

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

Good Standing Review A “Good Standing” review will be conducted internally by Eastpointe staff for both types of requests. If provider is found to be in “Good Standing” then the request will be forwarded to Provider Monitoring department for the next step of Onsite Review. If the provider is determined to be “Not in Good Standing” then the process will cease and a letter will be sent to the provider notifying them that they have not been approved to add or move a site.

Onsite Review Once Provider Monitoring has received the request, the onsite review will occur within 30 calendar days after Good Standing has been determined. Provider Monitoring will send the provider a two week notice and a copy of the review tool that will be used prior to performing the review.

Approval Letter Once the onsite review has been completed, the provider will receive a letter from Network Operations notifying them that the site has been approved. The approval will also give the provider instructions for the next steps.

Next Steps after site approval The provider must submit a Provider Change Form in order to have the approved site information uploaded in the Eastpointe Provider Choice Database/MCO Electronic System. The provider must submit an Authorization Transfer Form in order to move any current authorizations to the approved site. Both forms must be submitted to Network Operations via email networkoperations@eastpointe. net or fax 252 -407 -2450

Network Operations Updates Linda Hawley Isbell, MA, CI Director of Network Operations

End dating Licensed Independent Practitioners in Alpha

End Dating LIP’s All Licensed Independent Practitioners (LIP’s) who have their own contract and all LIP’s who provide outpatient services were required to submit a Re-Credentialing application last fall. We are now going in and end dating all LIP’s in Alpha who did not submit a Re-Credentialing application. This will not effect LIP’s who are part of teams because the service is billed not for the individual LIP.

Provider Choice Database

Provider Choice Database The Provider Choice Database has a listing of all of you or your agencies sites and services and is used to offer choice to members. The database is also used as a way to locate contact information to contact the provider when a member may be in crisis. This information may be used by the member or their family. We want to thank all providers who have submitted updates in a timely manner.

Provider Choice Database (cont. ) Please remember that it is the responsibility of each LIP and Agency who has a contract with Eastpointe to notify us of any changes in your information that is posted on the Database on an ongoing basis. Please use the Eastpointe Provider Change Form to make these updates.

Provider Choice Database (Cont. ) To make changes to your pages on the Database you need to go to our website then click on For Provider Community and then Provider Forms. You will need to complete the Eastpointe Provider Change Form and submit it to Network Operations. Please remember that this form must be complete and signed.

Prov. Choice Database- UTP If any required items are missing or incorrect an Unable to Process (UTP) letter will be sent to the provider. All of the other items will be processed except for those documented on the Unable to Process Letter.

Provider Specialties in Alpha

Provider Specialties If you need to make changes to the Provider Specialties that you have listed in Alpha please submit an Eastpointe Provider Change Form. Please remember that this is very important data that is used to assist members in choosing the appropriate provider for them.

Provider Meeting Topics

Provider Meeting Topics 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

Eastpointe Listserve

List Serve All list serve items may not be applicable for all contracted providers. This is a mechanism to provide information to all providers and you determine what information you distribute internally. One way some providers manage this is to assign someone in the organization to review the items and forward to the appropriate staff within the organization.

Eastpointe List Serve (cont. ) Directions for signing up for list serve: 1. Go to Eastpointe’s website at http: //www. eastpointe. net 2. Click on For Provider Community 3. Go to Provider Listserv, then click on Eastpointe Provider Listserv Sign-Up Form

Eastpointe List Serve (cont. ) 4. Enter your email address (make sure you type it correctly), enter your first and last name, and agency 5. Click on the Sign Up button 6. 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

Upcoming Provider Meeting

Provider Meeting Schedule Please remember to register for Provider Meetings on our website Under Provider Community Then Calendar of Events Our next meeting is scheduled for May 18, 2016 from 10: 00 am until 12: 00 pm and this will be a face to face meeting at the University of Mount Olive.

Questions? 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

Eastpointe Website Visit our website www. eastpointe. net to locate Communication Bulletins Manuals Provider Meeting Power. Point’s Provider Forms Training Announcements and Sign Up Provider Choice Database And so much more