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Contracting with Cardinal Providers During Realignment

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REMINDER: To begin the Alliance contract process, providers who are joining the network due to realignment will need to complete and submit the enrollment packet found below.

The first step in the contracting process is for providers to submit an enrollment application packet.

For providers who are not currently contracted with Alliance, please access the Mecklenburg and Orange enrollment application packet for non-contracted Alliance providers:

For providers who are currently contracted with Alliance please access the Mecklenburg and Orange enrollment application packet for contracted Alliance providers:

In order to ensure a contract is executed before the county realignment go-live date of December 1, 2021, please submit the applicable enrollment application packet no later than September 30, 2021. This will ensure ample time for Alliance to process applications in a timely manner and ensure that providers are able to continue to provide services when Alliance assumes responsibility for managing public behavioral health and intellectual/developmental disability (I/DD) services for Mecklenburg and Orange county residents on December 1, 2021.

Applications will be accepted after September 30 and will be processed in the order that they are received.

Alliance will review completed enrollment application packets as they are received and may reach out to applicants if there is missing/additional information or documentation needed. We encourage providers to submit a fully completed application packet with all the required attachments/documentation to facilitate the contracts in a timely manner. Alliance is committed to having provider contracts in place prior to the December 1, 2021, county realignment date.

HCBS information
Providers do not need to send approval letters, but are requested to send a spreadsheet of their HCBS sites.

Credentialing approval letters and contracts
Based on recent communication from NCDHHS, Alliance will not need the copy of the credentialing letter nor the contract as part of the enrollment application.

Transition Update for Providers Serving Orange and Mecklenburg Members

Provider contract status: Alliance continues to process contracts for Cardinal providers who were providing services to Mecklenburg and Orange members. To help ensure continuity of care for impacted members, Alliance has implemented a priority approach for the contracting process in the following order:

  1. Providers who have billed for Mecklenburg and Orange members as identified by claims history AND have submitted their enrollment packet to Alliance.
  2. Outreach to providers who showed a past claims history for Mecklenburg and Orange but have NOT submitted an enrollment packet.
  3. Providers contracted with Cardinal to serve Mecklenburg and Orange members who have submitted an enrollment packet to Alliance but who do not have any active claims data.

Contracts will have an effective date of December 1, 2021, for each situation.

Providers in priority category 1(active claim(s) for Mecklenburg and Orange members and an enrollment packet submitted to Alliance) have all been contacted by Alliance and are being asked to verify site and service information via a provider specific service spreadsheet.

This includes a smaller subset of providers who have claims that occurred more recently (between September 1, 2021, and November 30, 2021). Alliance will be contacting these providers within the next week to initiate the contract process.

As a reminder, providers are asked to carefully review the Medicaid and non-Medicaid rate sheets and benefit plans that can be found in the Alliance document library. Please review the codes, services, rates and the current crosswalk to ensure that providers are familiar with any service changes and so that providers can review their contract spreadsheet with accuracy.

In order to help facilitate the process, we would like to remind providers to ensure that their enrollment packets are submitted with all the information that was requested. See our website for details.

We are reminding providers to submit the required financial forms.

Please email [email protected] with any questions. Include as much detail as you can with your question so we can best address the questions.

Status of transitioning prior service authorizations: Alliance is actively uploading open authorizations received from Cardinal. Many authorizations have been successfully uploaded and are available in ACS. Authorizations are valid for upload if the member’s enrollment matches the authorized benefit plan, and the provider has an executed contract where the authorized service code is contracted at the individual site. We continue to research and resolve those authorizations that have not met the elements required to import into the system. Alliance appreciates your continued patience as we work to successfully resolve issues preventing authorized services from uploading into ACS.

Alliance Provider News Feed

Alliance is committed to ensuring that providers are aware of the information necessary to provide care to Alliance’s consumers and informed about any updates related to requirements and opportunities.

Alliance Health uses a news feed to update and communicate with providers. Providers are encouraged to sign up for the emails to ensure they receive prompt information. Sign up for our Provider News Service.

Provider Orientation November 17

Alliance held a provider orientation on November 17. If you were unable to attend, you can view the slides from the presentation or watch the replay below to hear questions and answers.

 

This page was last reviewed for accuracy on 09/22/2021