Welcome Harnett County!
On February 1, 2024, Alliance Health will begin to manage care for people who receive Medicaid or State-funded mental health (MH), intellectual and developmental disabilities (I/DD), and substance use disorder (SUD) services in Harnett County. Until February 1, 2024, these services will continue to be managed by Sandhills Center.
It is our pleasure to welcome Harnett citizens and providers to the Alliance Health Plan!
At Alliance, we always put members and their families first and work every day to help people lead healthier, more satisfying lives. We are working closely with Sandhills Center, Harnett County leaders, and the North Carolina Department of Health and Human Services to make sure that the shift to Alliance is as smooth and seamless as possible.
Provider Information Sessions
Join Alliance Health for a virtual provider information session to welcome providers serving Harnett County members and share information about LME/MCO consolidation and Alliance Health. This will be an opportunity to receive important information on provider contracting and how Alliance will support you during and after this transition.
If there are questions you would like to send ahead of the meeting, please email [email protected].
The virtual session will be held on January 24 from 3:00-4:00 p.m. Registration is required. Click here to register.
If you missed our first session, a recording is available.
Town Hall Meetings
These meetings are a chance to ask questions and share feedback about Alliance Health and services in Harnett County. They are hosted by Alliance Health and the Alliance Consumer and Family Committee (CFAC). These meetings are open to Harnett County residents, health care providers, and other stakeholders. You do not need to sign up to go to a meeting.
In-person Meeting
Wednesday, January 31, 5:30-6:30 p.m.
Training Room 103A, Resource Center and Library
455 McKinney Parkway, Lillington
Virtual Meeting
February 6, 5:30-6:30 p.m.
Join meeting at https://bit.ly/48HfVKc
Additional virtual meetings will be scheduled during the winter and spring. Please check back here for dates and times of future meetings.
Related Q&As
Providers / LME/MCO Consolidation /
What are the key dates provider should know?
Work to implement the necessary changes for LME/MCO Consolidation is already underway. Below are key dates that providers should be aware of in advance of consolidation.
• November 2023 – Ongoing: The four remaining LME/MCOs begin contracting with providers in their new assigned counties, if not already contracted.
• January 8, 2024 – January 18, 2024: Welcome packet sent to members/recipients from new LME/MCO.
• January 8, 2024 – January 20, 2024 Enrollment Broker sends new LME/MCO assignment letter to members
• January 15, 2024 – February 9, 2024: LME/MCOs perform warm handoff process for high needs members to newly assigned LME/MCOs.
• February 1, 2024: Consolidation go-live (effective date of coverage under the new LME/MCO for each impacted member/recipient.
Providers / LME/MCO Consolidation /
What information will be provided to impacted members?
Members will receive a package of educational materials and resources to help them navigate services with their new LME/MCO, including:
• An LME/MCO assignment letter from the NC Medicaid Enrollment Broker two to three weeks prior to consolidation go-live.
• New member welcome packets and Tailored Care Management (TCM) inserts (as appropriate) for their new LME/MCO, including the Prepaid Inpatient Health Plan (PIHP) welcome letter and member/handbook, to impacted members prior to consolidation go-live.
• Within one week of consolidation go live, new Medicaid ID cards will be issued with the name of their new LME/MCO. Note that members can keep using their old Medicaid ID cards until their new card is received.
Providers / LME/MCO Consolidation /
Is Alliance maintaining the same provider rates previously paid by Sandhills Center?
Alliance is committed to maintaining the provider rates previously paid by Sandhills Center. Providers serving Harnett members will continue to receive the same Medicaid rates that were in place prior to consolidation with Alliance Health.
Alliance has been analyzing the rates between Alliance and Sandhills and will be publishing an updated Medicaid and State fee schedule in the next few days. We strongly encourage providers to review the Alliance fee schedule and benefit plan to best understand procedure codes/rates and benefit limits as there may be some small differences that could affect your billing. Any questions that you have regarding this please reach out to your Provider Network Relations Specialist and they will assist you with any questions.
Alliance is committed to reimbursement consistency for our entire catchment area. To providers serving members in Cumberland, Durham, Johnston, Mecklenburg, Orange and Wake Counties, Alliance will publish rate changes by February 16th for services provided March 1, 2024 and after. These changes will include increases to the majority of services offered to our members. This will include Medicaid and State services.
Contracts have been sent out to Sandhill providers that served Harnett County members. More than 60% of the identified providers were already contracted with Alliance for the same sites and services and no additional contracting was required. If there were sites and/or services that needed to be added to your existing Alliance contract, you should have received a contract amendment. If you have served a Harnett County member in the past year and have not heard from Alliance please email us at [email protected] and please include the Agency name, NPI, Address and Service Code(s) that you would like Alliance to review to be considered. You may be asked to submit your Sandhills contract and/or billing Remittance Advice to demonstrate your eligibility.
Thank you for working with us and your members during this transition.
Providers / LME/MCO Consolidation /
Will members be reassigned to a new Tailored Care Manager provider?
From February 1, 2024 through May 30, 2024, members receiving Tailored Care Management provided by community-based TCM providers, will be able to keep their current providers. Community-based TCM providers will need to contract with the member’s new LME/MCO by April 30, 2024, to keep providing services and not have members reassigned to a new TCM provider.
Members receiving TCM provided by Sandhills Center care managers will be assigned a new TCM provider. If members prefer to get TCM from a certain provider, they should call their new LME/MCO and make the assignment request.
High needs members will be identified by the Department and prioritized by Sandhills and the LME/MCO assuming care to determine when warm handoffs (care manager to care manager live discussion regarding the key summary details and needs for each member) may be required.
The following populations will be included in this process:
o Members receiving in-home long-term services and supports (LTSS)
o Members authorized for transplantation
o Members who require complex treatment circumstances or multiple service interventions
o Members authorized for out-of-state services
o Members enrolled in Care Management for At-Risk Children (CMARC)
o Members in foster care who have been identified as Tailored Plan eligible
o Transition to community living (TCL) participants
o Other high need members or group of members identified by the Department or the health plan.
o Innovations waiver members (validated through Supplemental Questions (SQ) process for exceptional support needs or assigned an individual budget tool level of F or G).
Members can continue to see their primary care provider (PCP) and other NC Medicaid Direct providers for physical health services.
Providers / LME/MCO Consolidation /
Will members/recipients have access to the same services/benefits?
Yes, members will continue to have access to state-plan and waiver behavioral health, I/DD and traumatic brain injury (TBI) services. Additionally, the Department and LME/MCOs are reviewing Medicaid In-lieu of Services (ILOS) and State Funded Alternative Services offered by Sandhills to ensure a successful transition of those services.
Per the Department’s Transition of Care policy, LME/MCOs shall permit transitioning members to continue seeing their provider, regardless of network status following a transition between LME/MCOs and when the member is in an ongoing course of treatment.
For State-Funded Services, recipients will continue to have access to state-funded mental health, substance use disorder, I/DD and TBI services without interruption during the transition. This includes any Cross Area Service Program (CASP) services.
Providers / LME/MCO Consolidation /
Do I need to contract with my members'/recipients' new LME/MCO?
The LME/MCOs that will remain operational following consolidation have been encouraged to execute provider contracts prior to Feb. 1, 2024 to ensure members/recipients are able to more seamlessly access services during the transition.
Medicaid behavioral health, I/DD, TBI and TCM providers who are serving impacted counties but are not contracted with the LME/MCO that will assume area authority are encouraged to complete contracting activities as soon as possible to limit any disruption in services for members.
State-funded providers who are serving impacted counties but not contracted with the LME/MCO that will assume Tailored Plan authority under the new LME/MCO realignment are encouraged to complete contracting activities as soon as possible to limit any disruption in services for recipients.
Providers / LME/MCO Consolidation /
What happens if I haven't finalized a contract with my members'/recipients' new LME/MCO by February 1, 2024?
To ease beneficiary confusion and provider administrative burden, the Department and LME/MCOs will enact transition of care (TOC) flexibilities for a 120-day TOC period, detailed below.
Relax Medical Prior Authorization (PA) Requirements
• To alleviate burden to providers during the transition period, LME/MCOs are required to relax medical PA requirements for Medicaid-funded behavioral health and I/DD services for a duration of 120 days beginning February 1, 2024 through May 31, 2024.
• The Department has provided LME/MCOs with several recommendations on how this flexibility can be implemented. Providers should contact LME/MCOs they are contracted with to learn how this will be applied.
• Per the Department’s Transition of Care policy, LME/MCOs will also honor exisiting Medicaid behavioral health and I/DD prior authorizations.
• To alleviate burden to providers and ensure continuity of care during the transition period, LME/MCOs will be required to relax any existing prior authorization (PA) requirements for state-funded mental health, substance use disorder, I/DD and TBI services for a duration of 120 days beginning February 1, 2024 through May 31, 2024.
Out-of-Network Providers Paid at In-Network Provider Rates
• Between February 1, 2024 and May 31, 2024, medically necessary behavioral health and/or I/DD services will be reimbursed at the same rate for both in- and out-of-network providers.
• Out-of-network providers must still be enrolled in NC Medicaid to be reimbursed by the LME/MCO.
• Receiving LME/MCOs are strongly encouraged to do the same for medically necessary state-funded services.
Out-of-Network Providers Follow In-Network PA Rules
• Between February 1, 2024 and August 31, 2024, LME/MCOs receiving new counties may not require any additional requirements (i.e., PA and/or referral requirements) for out-of-network behavioral health and/or I/DD providers to provide services to transitioning LME/MCO members.
TCM Flexibilities
• For a duration of 120 days, beginning February 1, 2024, members will be able to continue to see their current TCM provider, regardless of contracting status with their new LME/MCO, for the TOC period.
• Members who are assigned to a provider-based TCM entity will not be reassigned as long as their current TCM provider completes a contract with the member’s new LME/MCO by the contracting deadline of April 30, 2024.
Providers / LME/MCO Consolidation /
How will claims and encounters be handled?
For all services provided to members/recipients who have transitioned from Sandhills, providers should follow these rules:
• Prior to consolidation go-live on February 1, 2024, all LME/MCOs will continue to process their own claims and encounters.
• For Sandhills and Eastpointe claims submitted after consolidation go-live (on or after February 1, 2024) that have a date of service prior to consolidation go-live (up to January 31, 2024), providers will continue to submit claims through LME/MCO legacy systems within timely filing and adjustment timeframe restrictions.
• For claims with a date of service on or after consolidation go-live (on or after February 1, 2024), providers will submit their claims to the LME/MCO that the member/recipient is assigned to for coverage.
• Providers are expected to file claims within the timely filing requirements in their contracts, however the LME/MCOs are encouraged to work with providers to reduce unnecessary denials during the transition.
Providers / LME/MCO Consolidation /
Will my reimbursement rates be impacted by the consolidation?
The Department will ensure that capitation payments to LME-MCOs support the preservation of provider reimbursement arrangements with Sandhills and Eastpointe.
Providers / LME/MCO Consolidation /
How will State funds be allocated?
To streamline the provider contracting process and ensure continuity of services, Sandhills will provide the remaining LME/MCOs a list of state-funded providers that are contracted to provide block grant, county, grant, and other pass-through funding. DMH/DD/SUS will review the populations moving to new LME/MCOs, as well as specific programs with unique funding, and will communicate with the LME/MCOs about how these dollars will transition as we get closer to consolidation go-live.
Providers / LME/MCO Consolidation /
What number do I call if I have questions?
To streamline the provider contracting process and ensure continuity of services, Sandhills will offer the following supports:
PROVIDER SERVICE LINE
Before February 1, 2024
▪ Providers can continue using the LME/MCO service lines for each member’s/recipient’s existing LME/MCO until January 31, 2024.
▪ For existing LME/MCO contact information, please reference the following:
▪ Alliance Health: 800-510-9132
▪ Eastpointe: 800-913-6109
▪ Partners Health Management: 888-235-4673
▪ Sandhills Center: 800-256-2452
▪ Trillium Health Resources: 877-685-2415
▪ Vaya Health: 800-962-9003
After February 1, 2024
For issues regarding members/recipients who are transitioning to Trillium:
▪ A single phone number for the provider service line will be selected.
▪ Calls made using the number that was not selected will be forwarded to Trillium for two months following consolidation go-live.
▪ After 60 calendar days post consolidation go-live, provider lines will be updated with a new IVR message that directs providers to the Trillium provider line for one month before being shut off.
For issues regarding members/recipients who are transitioning to Alliance, Partners, and Vaya
▪ Transitioning Sandhills members/recipients will begin receiving services under their new LME/MCO starting February 1, 2024. Questions regarding the provisioning of new services can be directed to Alliance, Partners, or Vaya depending on the members’/recipients’ assignment. Contact information for all LME/MCOs is listed above.
▪ For questions regarding services provided to Sandhills members/recipients with a date of service prior to February 1, 2024, providers will be able to contact Trillium for support.
MEMBER/RECIPIENT SERVICE LINES
Before February 1, 2024
▪ Members/recipients can continue using their current LME/MCO’s service lines through February 1, 2024.
▪ For existing LME/MCO contact information, please reference LME/MCO website links and numbers above.
After February 1, 2024
▪ A single phone number for member/recipient line will be selected as part of the consolidation.
▪ The member/recipientlines not selected will be updated with voice message for 60 calendar days post-consolidation go-live prompting members/recipients to call their new LME/MCO.
Providers / LME/MCO Consolidation /
What will happen with the Sandhills Consumer and Family Advisory Committee (CFAC)?
Sandhills is providing the following information to Trillium, Alliance, Vaya and Partners:
• List of CFAC members impacted by the transition and their contact information
• List of CFAC current initiatives underway in transitioning areas
• Plan for transitioning county CFAC and Governing Board representation
DMHDDSUS staff will use information received and work with all LME/MCOs and affected CFACs to develop and implement a transition plan. After February 1, 2024, Trillium or receiving LME/MCOs will act as the responsible party for maintaining ongoing engagement with local Consumer and Family Advisory Committees.
Providers / LME/MCO Consolidation /
Will LME/MCO consolidation impact Tailored Plan launch?
No. The Department and LME/MCOs continue to work together to prepare for Tailored Plan launch on July 1, 2024. More information about Tailored Plans is available here at Provider Playbook: NC Medicaid Managed Care | NC Medicaid (ncdhhs.gov).
