Please be aware that we have updated the Alliance Provider Operations Manuel to reflect our new name (Alliance Health) as well as our new home office address and a number of URLs and email addresses. Beyond these branding and administrative changes, no content changes have been made to the version of the Manual that became effective on March 2, 2019.
Please see the message from NC Tracks on behalf of Dave Richard regarding updates to Medicaid Managed Care. The message includes links to the information packets that are being mailed to beneficiaries, other resource materials, and webcast registration information.
The NC Department of Health and Human Services is committed to sharing information and updates about the transformation to Medicaid Managed Care, including open enrollment.
On July 15 at 2:30 p.m., join NCDHHS Secretary Mandy Cohen, M.D., and NC Medicaid team members for an update on NC Medicaid Managed Care implementation and a closer look at NC Medicaid Managed Care Phase 1 open enrollment activities. There will be an opportunity to ask questions. Registration is required to access the webcast.
Beginning July 1, 2019 the new procedure codes for RB – BHT goes into effect. The previously used procedure codes for ABA have been end dated for 6.30.19. Providers will see the new codes updated in their FY20 Medicaid Contract, they are currently in your Alpha Contract details effective 7.1.19.
Authorizations are currently in the process of being transitioned. Any new requests with effective dates 7.1.19 and forward need to request using the new codes.
A revised Alliance rate sheet has been posted.
NC Medicaid is hosting a statewide webinar on Tuesday, June 25, 2019, 1-2:30 pm regarding the NC Enrollment Broker who will be helping with the implementation of Medicaid Managed Care. The webinar is for any who have interest in North Carolina’s transformation to managed care, including stakeholders, providers, agencies and vendors.
Topics that will be covered in the webinar:
- How this transformation will affect the Medicaid population
- How this transformation will affect the Behavioral Health population
- Open enrollment dates
- Responsibilities of the prepaid health plans (PHPs)
- PHP comparison chart
- Role of the enrollment broker (EB)
- Partnership of the PHPs and EB
- Question and answer opportunity
The Child Flexible Funds Request Form has been revised. Please begin using this new version on July 1, 2019. Below is more information on Flex Funds:
Flex Funds are intended to supplement informal/volunteer resources and to improve the family and community’s ability to meet the service needs of children/young adults up to age 21. Child/young adult up to age 21 MUST be enrolled in a mental health, developmental disability and/or substance use (MH/DD/SU) treatment service managed by Alliance.
Flex Funds are to be determined by the Child and Family Team (CFT) or Care Review Team, when appropriate.
- All other sources of available revenues (i.e. Medicaid, Emergency Assistance, community partners) must be ruled out, and documented as ruled out, before Flex Funds may be accessed.
- All scholarships and/or sliding fees should be pursued prior to applying for Flex Funds, and the CFT should make every attempt to access no-cost, informal community supports.
- The use of Flex Funds should be cost-effective.
- Flex Funds may be requested once per fiscal year per child/young adult up to age 21 and shall not exceed $250.00. The $250 limit applies to the request as a whole even if the funds being requested would be used to assist the child/young adult up to age 21 who is enrolled in a MH/DD/SU service along with other family members. If multiple children/young adults up to age 21 in one family could benefit from the use of Flex Funds, separate requests could be submitted for each child/young adult up to age 21 who is enrolled in a MH/DD/SU service.
- Special consideration for funding above $250.00, or for more than one request per fiscal year per child/young adult up to age 21, will be reviewed based on the therapeutic needs of the child/young adult up to age 21 and the service/support being requested.
- The need for Flex Funds must be specifically documented in the Person Centered Plan (PCP) for recipients of an enhanced MH/SU service, Individual Support Plan (ISP) for recipients of Innovations waiver services, or outpatient treatment plan if the child/young adult up to age 21 is not enrolled in an enhanced MH/SU service or Innovations. The documentation on the PCP, ISP, or outpatient treatment plan should indicate how the use of Flex Funds would help meet the service needs of the child/young adult (up to age 21).
- Only requests showing therapeutic benefit for the child/young adult up to age 21 shall be approved. Flex Funds might be requested for the following:
- Services/goods for the child/young adult up to age 21 and/or family
- Services/goods to help strengthen the natural system of care or support for a child/young adult up to age 21 and their family
- Family support and sustenance which would enable the guardian/family to participate in treatment or improve the support for the child/young adult up to age 21
- Educational and vocational services not otherwise available or provided by the local school system
- Medical services not otherwise covered (i.e. eating disorder evaluation, independent living services/supports)
- Interpersonal and recreational skill development
- Additional positive reinforcers as determined by the CFT.
This is not a complete list, nor does inclusion on this list guarantee approval of a request. Please note that Flex Funds cannot be used to purchase gift cards or gas cards.
The All Provider Meeting will be held on Wednesday, June 19 from 1:00pm – 3:30pm at Alliance’s Home Office (5200 W. Paramount Parkway, Morrisville, NC). You can view the agenda here.
As FY19 comes to close, providers should be aware of finance year-end cutoff dates and reminders. Click here to read the year-end notice for providers.
The Alliance Medicaid Transformation webpage is designed to provide up-to-date information from the State regarding Medicaid Transformation. To assist with a smooth transition, Alliance is encouraging its providers to become familiar with Medicaid Transformation and what it means for our members. The page will be updated with new information as it comes in. Visit the Alliance Medicaid Transformation webpage.
There will be an All Provider Meeting on June 19, 2019, from 1-3:30 pm at the Alliance home office, 5200 W. Paramount Parkway, Suite 200, Morrisville, NC 27560. Click here to view the agenda.
Access and Information Center:
We want to make it easy for you to get the services or information you need. You can call the Alliance Access and Information Center toll-free 24 hours a day.
Representatives are available 8:30am-5:15pm Monday-Friday to answer provider questions about authorization, billing, claims, enrollment and credentialing, the Alpha Provider Portal or other issues.
Confidential Fraud and Abuse Line:
You are encouraged to report matters involving Medicaid fraud and abuse. If you want to report fraud or abuse, you can remain anonymous. Learn more.
Alliance maintains community offices in Durham, Wake, Cumberland and Johnston counties. Addresses and directions to the Alliance offices.