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||Authorization Request Information
- SMC Service Authorization Request Form
Please use the links below to download a copy of the Service Authorization Request form in Microsoft Word format. Please only use this form if you are having difficulty with our electronic Managed Care System, AlphaMCS.
This document will need to be printed, filled out, and faxed into our Care Management department for entry into our electronic Managed Care System.
||Inpatient and FBC Enrollment, Admission and
Continued Stay Procedures
In this section, you will find Smoky Mountain Center's procedures for enrollment, admission and continued stays for Inpatient and Facility Based Crisis Services. As you will see, there is a pass-through provision for these services before authorization review is required. However, notification and enrollment of consumers is required at the time of admission or soon thereafter. For facilities that have been working with SMC for management of state-funded services, you will see that approval by SMC's Mobile Crisis provider is no longer required for admission, although you will still work closely with MCM providers in many situations.
We recognize that these procedures are new for you and for us; we will work collaboratively with you to learn, implement and improve these procedures. Please feel free to contact any of the following individuals for assistance with these procedures:
- Toni Shelow, Psy.D., Senior Director Clinical Operations - 828-586-5501 ext. 1223
- Judith Collins, LPA, Care Management Director - 828-586-5501 ext. 1260
- Rachael Smith, MS, LPC, I/DD Care Management Manager - 828-586-5501 x1139
- Laura Woodrup, MS, LMFT, MH/SA Adult Team, Care Management Manager - 828-586-5501 ext. 5152
- Catherine Harlan, LPC, LCAS-A, MH/SA Child Team, Care Management Manager - 828-586-5501 ext. 1165
To speak to any available Care Manager please call 1-866-990-9712 and select Menu Option 5 when connected.
Smoky Mountain Center (SMC) Referral and Authorization Procedures
SMC Inpatient Concurrent Review Form for DSM-V
- ALL Notifications of Inpatient admissions must be made to SMC ASAP following admission and no later than
12:00 noon the first business day after admission.
- Notification, via the Regional Assessment and Referral Form (RARF), or equivalent clinical information,
is faxed to SMC secure Hospital Fax line: 877-260-6517.
- SMC UM staff will receive the notification of admission and will enter the SAR and enter an authorization for
pass-through days that will avoid weekend and holiday review
- Hospital providers do not need to call Access; their respective authorizations will be in AlphaMCS and provider
can view the effective and end dates in AlphaMCS
Facility Based Crisis Units (Synergy, Balsam Center, Neil Dobbins, Daymark Recovery)
- Notification of admission and pass-through process is defined above
- For 3-Way Contracted Beds, hospitals are restricted to their contracted number of beds at any time. Hospitals
are responsible for monitoring this limit and must know that SMC cannot authorize 3-Way Contracted patients beyond
that limit. (Cannon and Haywood Hospitals have a different arrangement involving other state fundsóplease confirm those
arrangements with your SMC Contract Manager.)
- Concurrent authorization requests must be made by submission of a complete and current SMC Inpatient Concurrent
Review Form faxed no later than 12:00 noon of the last covered day to 877-260-6517.
Alcohol and Drug Abuse Treatment Center (ADATC) Detox:
- ALL Notifications of FBC admissions must be made to SMC as SOON as possible following admission and no later than
12:00 noon the first business day after admission.
- Following notification, UM staff will enter an authorization for a 7-day pass-through for service unless the last
covered day ends on a weekend or holiday, in which case SMC will authorize until the next business day.
- For requested continued stay beyond 7 days, the SMC Inpatient Concurrent Review Form is required to be faxed to
SMC by 12:00 noon of the last covered day at 877-260-6517.
Alcohol and Drug Abuse Treatment Center (ADATC) Rehab:
- Referrals to ADATC Detox service begin with the referring provider contacting ADATC to conduct a telephonic review.
If ADATC accepts the referral for admission, they will give a verbal approval and will provide the name of the ADATC
- Upon ADATC acceptance of the consumer, the referring provider faxes the Regional Referral and Acceptance Form (RARF)
and the ADATC attending physicianís name to the Regional Mobile Crisis Management (MCM) provider.
- The referring entity then contacts the Regional (MCM) provider by non-emergency phone line to notify them that the RARF
and referral information have been faxed.
- MCM will generate an ADATC referral number and fax the RARF and referral information to ADATC, signifying LME approval
of the referral.
- MCM will then contact the referring provider as soon as possible that the consumer can be transported to the ADATC.
For Broughton State Hospital (BSH):
- For ADATC Rehab admissions, the referring provider faxes the State Referral Form with all required documentation to
SMC at 877-651-9968.
- SMC will notify the referring facility of available Rehab admission date. If the consumer has been discharged from a
referring inpatient facility, SMC will contact consumer directly and not the referring provider.
- Concurrent review is required for ADATC Rehab stays longer than 14 days; the ADATC will fax the continued stay- state
Form 59912 to SMC at 828-452-3473.
- An SMC Care Manager will review for medical necessity and with fax the continued stay state form to ADATC.
For referrals to Broughton State Hospital (BSH):
- The referring provider completes the 3-page state Regional Referral Form (RRF) and faxes it together with the
RARF (and/or Clinical documentation) to the Regional Mobile Crisis Management (MCM) provider.
- The referring provider then contacts the Regional (MCM) provider by non-emergency phone line to notify them that the
RRF and the RARF have been faxed.
- MCM will review the referral information and forward to BSH with the referral number.
- The referring provider faxes the RARF and other clinical information to BSH for review at 828-433-2082
- For DD Diversion, MCM will complete the IDD Exception worksheet that is required to be submitted with the RRF for BSH
referrals on IDD clients.
- For requests to transfer a patient from another Inpatient Psychiatric Unit to BSH, the facility should contact the SMC
Care Management Department during business hours at 866-990-9712, option 5 to discuss the requested transfer.
Psychological testing is the use of formal procedures employing reliable and valid instruments to measure intellectual, cognitive, emotional and behavioral functioning. Psychological testing may be used to identify psychopathology, personality style, interpersonal processes, and adaptive skills. Neuropsychological testing is a specialized area of psychological testing that can identify the presence of brain damage, injury or dysfunction and associated functional deficits. Both types of testing require the application of appropriate normative data for interpretation or classification. Testing may be used to guide differential diagnosis in the treatment of psychiatric disorders and disabilities or to provide an assessment of cognitive and intellectual abilities, personality and emotional characteristics and neuropsychological functioning.
Smoky Mountain Center (SMC) recognizes the importance and value of psychological testing to address specific diagnostic questions necessary for an individual's treatment that cannot be answered through diagnostic interview and psychiatric evaluation. Before conducting psychological testing, it is important to obtain current clinical information through a Comprehensive Clinical Assessment and/or Psychiatric Evaluation. It is also important to inquire about other psychological testing that may have been conducted with the individual and to obtain copies of such evaluations before conducting psychological testing.
The links in this document are provided as a convenience to readers of this webpage. Smoky Mountain Center is not responsible for their content. In addition, please note that information provided here is not a substitute for professional clinical advice.
Serving individuals with mental health, developmental disability and substance abuse issues in
Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon,
Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey Counties
For Immediate Help, Call 1-800-849-6127 For Customer Services, Call 1-888-757-5726 For TTY Calls, 1-800-855-2280
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