Interested in becoming a Network Provider with Alliance Health? Our Credentialing and Enrollment page provides everything you need to know.
- At this time we are not accepting applications for network membership at large. However, from time to time, targeted service needs may be identified and these will be posted on this website and in the Alliance provider news feed. View any service needs currently in effect.
- 1 Important Information
- 2 Credentialing FAQs
- 3 Credentialing Staff Assignments
- 4 Agency Recredentialing
- 5 Unlicensed AFL Site Additions
- 6 Innovations Residential Supports-Licensure and Application
- All fully-licensed and Associate-licensed outpatient therapists need to be credentialed by Alliance. Please ensure enrollment applications are submitted for all of these clinicians.
- Alliance’s Credentialing Department requires that all applications and subsequent required documentation be submitted via email attachment only. Anything received via fax, mail, delivery service or by dropping off at office will not be accepted. All credentialing information can be emailed to [email protected].
- Currently contracted agencies and group practices that wish to add additional clinicians will be required to complete a Request to Add Licensed Clinician.
- This form will be reviewed and a checklist of needed documents, along with the application, will be emailed to the requesting provider. The application and required documents will need to be submitted in its entirety or the application will not be accepted and will be returned to the provider. Applications that are received outside of this process will be returned to the provider.
Changes Effective July 1, 2017
Per NC DMA (Joint Communication Bulletin #J240), effective July 1, 2017 Alliance will no longer be able to enroll new providers (including new sites) in NCTracks via the Provider Upload process. However, all providers (including new sites) are required to be enrolled in NCTracks in order to also be enrolled in the Alliance Behavioral Healthcare Network.
Alliance strongly recommends that providers and sites that are currently going thru the Alliance credentialing process and any future enrollment/credentialing requests and are not currently enrolled in NCTracks, to enroll in NCTracks effective immediately. Alliance will not be able to enroll providers in Alpha until the provider is successfully enrolled in NCTracks.
Alliance will continue to credential providers. Effective June 12, 2017, providers may receive two notification letters from Alliance. A provider will receive a credentialing letter once a credentialing decision has been made. However, if a provider is not enrolled in NCTracks the provider will not be enrolled in Alliance and entered into Alpha until the provider is successfully and correctly enrolled in NCTracks. Providers are responsible for notifying Alliance at [email protected] once they are enrolled in NCTracks. The provider will receive a separate enrollment letter from Alliance once Alliance is able to confirm verification that the provider is enrolled correctly in NCTracks. If a provider is enrolled in NCTracks at the time the credentialing approval is completed they will receive only one letter, a Credentialing/Enrollment approval letter.
Access Frequently Asked Questions.
Members of the Alliance Provider Network are required to purchase and maintain certain types and amounts of insurance from a company licensed and authorized to do business in the State of North Carolina by the North Carolina Department of Insurance. Get full details on the insurance requirements and see below for special additional information for specific groups of providers.
Professional Liability Insurance Requirements for Agencies and Groups that Provider Outpatient Therapy
- Agencies and groups that provide outpatient therapy and/or psychiatric services must list each practitioner on the agency/group professional liability insurance certificate who are credentialed with Alliance. Alliance requires a copy of the agency/group professional liability insurance certificate and/or attachments on the insurance company’s letterhead that lists the practitioner and coverage limits or the attestation letter and copy of the agency/group insurance certificate when an enrollment application is submitted for each practitioner. Access a sample attestation letter.
- Agencies may also submit a certificate for their agency that lists all of their practitioners to help reduce numerous requests to insurance companies. When adding new practitioners, agencies would be required to submit the updated professional liability certificate with the new practitioner added. This includes any practitioners (both contractors and employees) that are billing under the agency
- If the agency/group covers the practitioner (contractor) under a vicarious liability policy, the practitioner is required to have their own individual policy that meets the professional liability criteria ($1 million to $3 million).
Important Information for LIPs in Solo Practice Concerning Comprehensive General Liability Insurance
To be in accordance with Alliance’s contract with the State all contracted LIP solo entities will be required to purchase and maintain Comprehensive General Liability Insurance which includes Bodily Injury and Property Damage Liability Insurance protecting the provider and any employee performing work under the Contract from claims of Bodily Injury or Property Damage arising from operations under the Contract for an amount of not less than $1,000,000.00 per occurrence/$3,000,000.00 annual aggregate. Currently contracted LIP Solo Providers will be required to email by April 15, 2018 a copy of the above policy with an effective date of no later than July 1, 2018 to [email protected]. Contracts will not be renewed for providers that do not submit this required insurance information. Any new LIP Solo providers initially credentialed and/or contracted with an effective date after October 25, 2017 will be required to have this coverage to meet credentialing and contracting requirements. Questions can be submitted by email.
Notifying Alliance of Changes in Business Operations
- All providers are required to notify Alliance at [email protected] in advance regarding potential site address changes, mergers/acquisitions, name or tax ID changes, or any other potentially significant changes that may be under consideration. Alliance staff will work with providers to identify any issues that may arise due to potential changes and how to best navigate within the MCO model around these changes.
Site Visit Requirement
- Effective for all applications received after February 1, 2015: All Providers being considered for a Network Contract will be required to have and pass an on-site visit by Alliance Provider Network staff prior to enrollment into the Network. This applies only to Providers applying for services/sites that are NOT licensed by DHSR. Providers will be contacted by a Provider Network staff to set up a site visit after your Credentialing application has been accepted and all required documents and verifications have been completed. Alliance strongly encourages Providers to review the initial on-site visit tool to prepare for the visit.
- Effective October 1: Alliance will begin utilizing the DHHS New Unlicensed Site Review Tool for any current provider that has approved address changes or approved address additions for unlicensed sites to their current contract. This site visit needs to be conducted no later than within 30 days of the change. The need for the site visit will be identified once the provider has submitted the Notice of Change form indicating the address change or addition. Advance notification and subsequent approval of any address change or addition are required. Providers are encouraged to review the tool prior to the site visit.
What is the process for adding a clinician to my agency?
- Agency sends the completed Add Licensed Practitioner Request Form to [email protected].
- Provider Network Operations staff will review the request to determine if the LP is already credentialed with Alliance.
IF LP IS ALREADY FULLY CREDENTIALED WITHIN THE ALLIANCE NETWORK:
- If the LP is already fully credentialed with another agency, Provider Network Operations will reply to the request asking for the agency’s Certificate of Liability Insurance with the clinician listed or an attestation letter.
- Once Provider Network Operations receives the fully-completed requested information, the provider will receive an email stating all information has been received.
- Provider Network Operations will then forward to a Credentialing Specialist, who completes the following tasks:
- Confirm credentialing status of the LP.
- Confirm agency is a contracted provider.
- Confirm that agency and practice address listed on the application is approved for Outpatient Services.
- All LPs are required to be fully registered with NC Tracks. If the LP is not fully-registered in NCTracks (affiliation with agency and DMH Benefit Plan chosen) they will be added to Alliance upload to send the LP information to NC Tracks.
- The Credentialing Specialist will then link them to the agency in Alpha based on the date Alliance received the completed enrollment packet.
- Once the LP is linked in Alpha, Alliance will send an email verifying that the LP is linked to the agency to provide Outpatient Services to Alliance enrollees. If the Agency also has a State contract and the LP is not in NCTracks (as indicated in #5 above) the email will also state the LP is not approved to provide Outpatient Services to State contract consumers.
IF LP IS NOT CURRENTLY CREDENTIALED WITHIN THE ALLIANCE NETWORK:
- Provider Network Operations will review CAQH database to determine if the LP is already connected to CAQH. If the LP is registered with CAQH:
- Provider Network Operations will add them to the Alliance CAQH roster
- CAQH application must be current (dated within 14 calendar days) and complete.
- If clinician is not registered with CAQH Provider Network Operations will email agency directions on how to complete the CAQH online registration and NC State standardized application.
- Provider Network Operations will email the provider a credentialing enrollment packet which will include a checklist indicating what needs to be completed. The credentialing packet must be emailed to Alliance to start the credentialing and enrollment process.
- Once Alliance receives the email with the enrollment packet from the provider:
- The application is reviewed for completion (including review of the CAQH as well as the items submitted). All signatures should be dated within 14 calendar days of submission.
- If items are missing and/or incomplete Provider Network Operations will not be able to accept the application. The enrollment packet will be rejected/returned to the provider with an explanation of what is missing/incomplete.
- If the enrollment packet is not accepted by Alliance and returned to the provider:
- The provider must provide the information that has been identified as missing or incomplete (including any updates to CAQH).
- The provider should not return the packet until all elements are updated (including CAQH).
- If the packet is submitted with missing information it will be deemed incomplete and returned to the provider.
- Please note that the entire packet will need to be resubmitted each time.
- Once Alliance receives a completed enrollment packet the provider will receive an email from Provider Network Operations stating that the application has been accepted. LPs will not be added to Alpha for billing until the credentialing application is approved by Provider Network Credentialing Committee. The effective date will be the date the enrollment packet was accept.
- The LP packet will be forwarded to the Credentialing Specialist who is assigned to the agency to complete the full credentialing process.
- The Credentialing Specialist will process the application for full credentialing
- If additional information is needed during the full credentialing process, the Credentialing Specialist will send an email that will outline what is needed and timeframes that information needs to be submitted.
- This email will be sent to both the LP and the agency.
- If information is not received within time frames identified in request the application will be deemed incomplete and will not be processed any further. The agency will receive written notification of this decision.
- If the Agency wishes to submit an application in the future for the LP, the process will start over.
- Effective dates will be dated to the date the completed enrollment packet was received and accepted by Alliance.
- Once any additional information is obtained and the Credentialing Specialist completes the primary source verification process the LP’s enrollment packet will be forwarded to the Provider Network Credentialing Committee for a decision regarding approval as an LP in the Alliance Network. The Credentialing Committee meets a minimum of twice a month.
- Once the Provider Network Operations Credentialing Committee makes a decision the agency and the LP will receive written notification of the Committee’s decision.
- If Alliance enrolls the clinician into NCTracks the CEP authorization number for NCTracks will be included on the credentialing approval letter.
What are the credentialing requirements for Nurse Practitioners, Psychiatric Nurse Practitioners, and Physician Assistants?
In addition to DMA Clinical Coverage Policy 8C requirements, Alliance that Psychiatric Nurse Practitioners, Nurse Practitioners and Physicians Assistants who are credentialed with Alliance have a supervision agreement with a licensed Psychiatrist. Alliance maintains this and other credentialing requirements to help ensure that our providers have the appropriate experience and psychiatric oversight to best serve our enrollees.
Does Alliance credential and enroll non-psychiatrist MDs?
Alliance operates a closed network and is credentialing and enrolling only MDs that are psychiatrists. Alliance maintains this and other credentialing requirements to help ensure that our providers have the appropriate experience and psychiatric training to best serve our enrollees.
How will we know when network is open to add new providers/services?
When Alliance has a need for new services/providers, the information will be listed on our website on the home page and/or main credentialing page.
Why is it important to provide Alliance with an up to date LP Roster?
With an updated LP Roster we are able to compare the clinicians that are currently employed with your agency to the ones that are linked to the agency in Alpha. To bill for services provided by a clinician to Alliance consumers they must be fully credentialed and linked to your agency in Alpha.
If I filled this form out six months ago why do I have to complete it again?
All documents that include a signature and date must be less than 180 days old by the time the Provider Network Credentialing Committee conducts final review.
May I go ahead and submit my application when I submit my request to add clinician form?
When submitting the request form do not include anything else with it. The forms that need to be completed will be emailed to you. We will not be able to accept any additional forms that you send with the request to add form.
Unlicensed AFL Site Additions
Effective March 1 Alliance will no longer set-up unlicensed AFL homes as individual sites in provider contracts. All levels of Innovations Residential Supports for unlicensed AFLs will be linked to the providers’s Main/Corporate site in Alpha. Alliance I/DD UM (Utilization Management) is currently moving existing authorizations from the individual site to the provider’s Main/Corporate site.
All existing Residential Supports authorizations for unlicensed AFLs have been moved to the appropriate site location. All future authorization requests for Residential Supports for unlicensed AFLs should be requested at the provider’s Main/Corporate site location. Alliance I/DD UM will no longer authorize unlicensed AFL services for the Waiver Participant’s individual site location.
Contracted providers are no longer required to submit Unlicensed AFL Site Enrollment Forms to the Provider Network email address. However, if a Waiver Participant moves to a new Unlicensed AFL at any time, this must be reported to the member’s I/DD Care Coordinator immediately so that the member’s plan information can be updated. Providers should ensure that claims submitted for payment are consistent with the authorized site to avoid delay in payment. An updated contract amendment will be emailed to the applicable Providers.
Providers are required to continue following the current Out of Network Process for licensed AFLs and/or licensed group homes.