Smoky Mountain Center | For Immediate Help Call 1-800-849-6127
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Consumers’ privacy rights are addressed in Smoky Mountain LME/MCO’s Notice of Privacy Practices.
Authorization Info
Are you NC-TOPPS Compliant?
ATTENTION PROVIDERS:
Are you NC-TOPPS compliant? All NC-TOPPS questions or requests for assistance should be emailed to nctopps@smokymountaincenter.com.
This is the quickest way to get answers and remain compliant with NC-TOPPS requirements for providers.
Are you NC-TOPPS Compliant?

 

Clinical Decision Tools Used by SMC Care Managers

  1. Service Definitions
  2. SMC Level of Care Guidelines
  3. PCP Manual
  4. SMC-Developed Review Tools and Internal Flow Charts

 

Special Processes Documents

 

Authorization Request Information

SMC Routine Authorization Request Review Tool - UPDATED 7/5/2011

Medical/Clinical Necessity Criteria
Medical/Clinical Necessity Criteria adopted from the Division of Medical Assistance document, "LME UM Requirements and Procedures", issued 11/14/08, section VII A and B

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

Attached are 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:
  • Fanny Gosselin, LCSW, LCAS, Care Manager - 828-586-5501 ext. 1220
  • Judith Collins, PA, MH/SA Care Management Supervisor - 828-586-5501 ext. 1260
  • Toni Shelow, Psy.D., Care Management Director - 828-586-5501 ext. 1223
  • Steve Puckett, Ph.D., Senior Director, Clinical/UM - 828-586-5501 ext. 1232

 

Psychological Testing

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.

URAC Accredited HEalth Network, Health Utilization Management, Health Call Center


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, contact Relay NC at 711
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