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2015 Smoky Mountain LME/MCO DRAFT Provider Operations Manual
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Consumers’ privacy rights are addressed in Smoky Mountain LME/MCO’s Notice of Privacy Practices.
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Provider Phone Line:  1-866-990-9712


Smoky Mountain MCO Accepted Behavioral Health Taxonomy List (updated 04/25/16)

Join the Smoky Provider Network Bulletins Email List

Important Notifications for Providers:

Updates to Bridge Funding
The current state budget does not provide bridge funding. As a result, other funding, known as Replacement Bridge Funding will be utilized by Smoky. Eligibility criteria for Replacement Bridge Funding will follow the Division's previous requirements. Others who are not eligible for Replacement Bridge Funding include:
  • Individuals who receive Innovations funding
  • Individuals strictly receiving MH services
  • Individuals who receive state-funded residential services at a bundled or specialized service rate
  • Individuals who receive supervised MR/MI state-funded services.
Replacement Bridge Funding Instructions (FY 15-16)
Replacement Bridge Funding Invoice (FY 15-16)

ATTENTION Innovations Waiver Participants and Providers
Notice of Class Action Settlement: In accordance with the NC Department of Health and Human Services' December 2014 settlement in L.S. v. Brajer, 5: 11-CV-354, please refer to the attached information regarding the Plan of Care (ISP) process for Innovations Waiver participants. To the extent that any of the information in this attachment is inconsistent with information appearing in any handbook or publication issued by Smoky Mountain LME/MCO, this Attachment supersedes any inconsistent information appearing in the handbook or publication.

Plan of Care (ISP) process for Innovations Waiver participants

Smoky Mountain LME/MCO Network Development Plan

Benefit Plan Streamline Presentation for Provider Council July 16, 2014

Questions and Concerns from the Provider Network Council on State Target Pop and DSM-5

Important Communication for Providers about Local Modifier Codes
This is an important communication. The information detailed in this communication affects MANY providers. Please pay careful attention to the information below. Please ensure this communication is forwarded to your billing staff, billing vendor or clearing house representatives that may be responsible for submission of claims and claim files to SMC. Please click the link below for more information:

(SMC Communication #26-2013)-Local Modifiers

Presentation for the 2015 NCHIMA Behavioral Health Conference

Changes have been made to the Provider Monitoring Tools
LIP REVIEW TOOL --As a quick reference, a note has been added to let people know that this tool is used with LIPs who provide outpatient/basic benefit services only and that the sample size for a solo practice and group practice are also noted. There is also a note explaining that the Routine Agency Tool is used when a LIP works in an agency that provides services other than basic benefit services.

LIP OFFICE SITE REVIEW TOOL --The guideline for item #1 re: the accessibility of the office for individuals who have physical disabilities clarified the options available when the clinician's office is located in a building that is not wheelchair accessible.

--The note in the guideline for item #11 re: the practice hours, provisions for 24 hour coverage being posted as only being applicable to Cardinal Innovations was deleted since this requirement applies to all LIPs, not just those who contract with Cardinal Innovations and to be consistent with the tool.

AGENCY REVIEW TOOL --On the Unlicensed AFL Tool, the guidelines for emergency information and the requirement for crisis services training have been inserted and the guidelines for items #5 and #6 which were combined have been separated to be consistent with the tool.

--The following lists have been added to the workbook to allow reviewers to document the individuals included in the samples for incidents, complaints, restrictive interventions and for funds management and the medication review. The Individual Records List and the Post-Payment Review List have been consolidated into one list -- the Sample Based on Paid Claims List -- in order to reduce redundancy.

--The formula for the Diagnostic Assessment on the Overview Summary page was corrected.

--A note was placed on the Routine Agency Tool to indicate that this tool is used for LIPs who work in an agency that provides services other than basic benefit services (e.g., CABHAs).

More information can be found on the NC DHHS Provider Monitoring page -
http://www2.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm

DHHS Provider Monitoring Tools for LME-MCOs

SMC Medicaid Fraud and Abuse Hotline Poster

Smoky Mountain LME/MCO (SM LME/MCO) is a Local Management Entity (LME) / Managed Care Organization (MCO) that currently monitors State and Medicaid mental health, intellectual and developmental disability, and substance abuse funding for its 23-county catchment area consisting of 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.

Download the DRAFT Smoky Mountain Provider Operations Manual
Updated September 2015


Serving individuals with mental health, developmental disability and substance use 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
URAC Accredited Health Call CenterURAC Accredited Health Utilization ManagementURAC Accredited Health Network
For Immediate Help, Call 1-800-849-6127                    For Customer Services, Call 1-888-757-5726                    For TTY Calls, contact Relay NC at 711
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