Provider Enrollment

Alliance is currently accepting applications for all behavioral health services required under the NC Medicaid Plan, except for services within our closed network (see below). Any targeted service needs will be posted on our website and in the Alliance provider newsletter. Check for current service opportunities.

We are currently accepting applications from physical health providers for Tailored Plan members.

Practitioners who are joining or are associated with currently contracted behavioral health provider entities or physical health providers that are contracted for the Tailored Plan do not need to send in any additional information. Alliance uses daily files from the NCTracks system to autopopulate our Alliance Claims System (ACS). This information includes practitioner provider affiliation and other data needed for billing, the provider directory, etc. Please ensure that your NCTracks information is up to date to ensure current information in the Alliance system

Legal Authority

In accordance with North Carolina General Statute § 108D-23(c), Alliance is required to maintain a closed network for specific behavioral health and intellectual/developmental disability services.

What is a closed network?

A closed network means that Alliance contracts with a limited number of qualified providers to deliver these specialized services, rather than allowing any willing provider to participate in the network.

Services Subject to Closed Network Requirements

The following services fall under the closed network authority established by NCGS § 108D-23(c):

Mental Health Services

• Assertive Community Treatment (ACT) – Intensive, team-based community mental health service
• Multi-Systemic Therapy (MST) – Intensive family and community-based treatment program
• Community Support Team (CST) – Community-based support services
• Intensive In-Home Services – High-intensity therapeutic services delivered in the home
• Child and Adolescent Day Treatment – Structured therapeutic programming for youth

Substance Use Disorder Services

• SUD Residential Treatment Services – Including all ASAM levels:
• ASAM 3.1 (Clinically Managed Low-Intensity Residential Services)
• ASAM 3.3 (Clinically Managed Population-Specific High-Intensity Residential Services)
• ASAM 3.5 (Clinically Managed High-Intensity Residential Services)
• ASAM 3.7 (Medically Monitored Intensive Inpatient Services)

Intellectual and Developmental Disability Services

• Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IDD)

1915(b)(3) Waiver Services

• 1915(c) Home and Community Based Innovations Waiver – All services under this waiver
• 1915(c) Home and Community Based TBI Waiver – All traumatic brain injury waiver services
• 1915(i) Home and Community Based Waiver – All services under this state plan option
• 1915(b)(3) Waiver Services including:
  • Individual Support
  • Intensive Recovery Support
  • In-Home Skill Building
  • One-Time Transitional Costs
  • Respite Services
  • Supported Employment
  • Transitional Living Skills

Impact on Providers

Providers interested in delivering these services must go through Alliance’s specific contracting and credentialing processes. These services are not available through our standard network participation agreements. Access our current service needs list.

Questions?

For questions about closed network services or contracting requirements, contact the Provider Relations team at [email protected].

Please note that all providers need to be enrolled in the NC NCTracks system. If you are not enrolled in NCTracks please contact NCTracks to be enrolled prior to submitting an application to Allliance.

Providers are required to submit a fully completed Provider Application request to be considered for a network contract. Once the Provider Application request is received it will be reviewed for specific network need and eligibility to be considered for a network contract. Providers will be notified within five business days regarding the outcome of the decision.

Providers that are eligible to move forward with a network contract will receive communication from our Enrollment/Contract team to identify any additional information needed for contracting.

Once that information is submitted and reviewed for completeness a network contract will be sent via DocuSign. Once the contract is fully executed a welcome letter is provided which outlines important provider information including orientation, important claims, and UM and important provider information, and identifies your Provider Network Relations Specialist. Provider details will be entered into our Alliance Claims System (ACS).

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.

The provider shall purchase and maintain the following minimum coverage:

1. Professional Liability: Professional Liability Insurance protecting the Provider and any employee performing work under the Contract for an amount of not less than $1,000,000.00 per occurrence/$3,000,000.00 annual aggregate.
2. Comprehensive General Liability: 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.
3. Automobile Liability: If Provider transports Enrollees, Automobile Bodily Injury and Property Damage Liability Insurance covering all owned, non-owned, and hired automobiles for an amount not less than $500,000.00 each person and $500,0000.00 each occurrence.  Policies written on a combined single-limit basis shall have a minimum limit of $1,000,000.00.
4. Workers’ Compensation and Occupational Disease Insurance, Employer’s Liability Insurance: Workers’ Compensation and Occupational Disease Insurance as required by the statutes of the State of North Carolina and Employer’s Liability Insurance for an amount not less than Bodily Injury by Accident $100,000.00 each Accident/Bodily Injury by Disease $100,000.00 each Employee/Bodily Injury by Disease $500,000.00 Policy Limit.
5. Tail Coverage: Liability insurance may be on either an occurrence basis or on a claims-made basis.  If the policy is on a claims-made basis, an extended reporting endorsement (tail coverage) for a period of not less than three (3) years after the end of the contract term, or an agreement to continue liability coverage with a retroactive date on or before the beginning of the contract term, shall also be provided.
6. Any provider utilizing any model for self-directing Innovations services and/or Agency With Choice services for Innovations enrollees shall carry Workers Compensation Insurance in accordance with the requirements of the DHB and Alliance Tailored Plan Contract and Innovations Waiver §1915(c) rules.

All providers are required to notify Alliance at [email protected] at a minimum of 30 days 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. Please complete a Notice of Change Form indicating any changes and submit to [email protected]. Providers are also strongly encouraged to contact their Provider Network Relations Specialist regarding any questions about changes, etc.