eastpointe july 15, 2015 10:00am until 1:00pm webinar · if you send in the client update, please...

Eastpointe July 15, 2015 10:00am until 1:00pm Webinar

Welcome and Overview Linda Hawley Isbell

Eastpointe Provider Network Council Barry Dixon

Insurance Reminders Jessica Plummer

Network Operations Call Center Melanie Weatherford

Network Operations Linda Hawley Isbell Alpha and Provider Choice Database Updates

Moving or Adding a Site

Re-credentialing

Discharges in Alpha

External Operations Karen Salacki

Current Applications Accepted

Provider Meeting Topics

Listserve

Local and State Updates

Next Provider Meeting

Barry Dixon Eastpointe Provider Network Council

For Council Information: Go to www.eastpointe.net, then For Provider Community, the Eastpointe Provider Network Council Information

Contact Information: [email protected]

http://www.eastpointe.net/mailto:[email protected]

We regularly review all Certificates of Insurance (COI’s) for each Provider who has a contract with Eastpointe to ensure that all elements of the contract as related to insurance are in compliance.

Providers are notified via email and/or certified letter if we see a gap or lack of insurance to request an updated copy of the Certificate of Insurance.

Please review your LIP, Agency or Hospital contract to make sure that your Certificate of Insurance (COI) meets the requirements of the contract.

Please make sure that the COI has the same name on it as your contract.

Please make sure that the required amounts of insurance listed in your contract match what is on your COI.

Please ensure that during the renewal of insurance coverage that the updated Certificate of Insurance (COI) is mailed to Eastpointe 15 days prior to expiration.

If you have an LIP contract, you must have General Liability in addition to Professional Liability. If you are renting space, the Homeowners Insurance that your landlord has does not meet the criteria for the required General Liability as described in your contract.

If you have a contract that is in your name with a “dba” and your company name, both of these names need to be listed on your Certificate of Insurance (COI).

Example: Linda Hawley Isbell dba Isbell Company

Please note that we verify insurance status before any amendments are made to contracts. This includes name changes and mergers.

We also verify insurance at the time that any Provider requests to terminate their contract.

Melanie Weatherford

Network Operations Call Center handled 9,243 Total Calls for the Fourth Quarter (April- June), 2015

Alpha recommends using Internet Explorer version 9.0 or higher or Firefox version 10.0 or higher for best functionality. Screen resolution- The best screen resolution is 1360x765. This will allow you to see all the tiles and navigate easier. Whenever there is a prepopulating field, it is important to choose from the drop down menu so the system will recognize the data.

If you send in the Client Update, please be sure to indicate in the comments box what needs to be updated. When completing a patient search in Alpha to determine if an enrollment should be completed, please look at the insurance to see if it is active. If the insurance is not active/end dated or you do not see insurance listed at all, an enrollment needs to be completed. A Client Update Request should be completed when you need to make changes to the members information such as a DOB, correction of name, diagnosis. Please also verify the spelling of a name, the correct DOB when completing a patient search or you will not be able to locate the member in Alpha. Please have all the required UM information below ready at the time of requesting a Peer to Peer, SAR ID, record # Member name, Provider name, contact name and contact working number for a Peer to Peer Request when calling Network Operations. This will help facilitate the call.

When completing the SAR and you discover that you put in a wrong site for example after it has already been submitted for review. The provider will need to request that the incorrect SAR’s be withdrawn when they submit another authorization. It will need to be documented to withdraw the previous authorization due to incorrect site. These comments will be noted in the SAR Justification Box.

Providers that try to login to the Alpha Portal that get an “invalid User” error. In many cases it is because an incorrect web address is being used to access Alpha. The correct one is: https://login.alphamcs.com/alphamcs/AlphaMCS.aspx#/Views/Portallogin.xaml I am not able to access a service that is listed on my contract? If the provider did not submit the site forms in to indicate that service it was not added to the provider’s contract details. Please submit a Eastpointe Provider Change Form to request the service being added in Alpha.

https://login.alphamcs.com/alphamcs/AlphaMCS.aspx/Views/Portallogin.xamlhttps://login.alphamcs.com/alphamcs/AlphaMCS.aspx/Views/Portallogin.xaml

Password Reset and new Alpha Logins- Please continue to submit these request to IT support through your agency’s security officer except for Hospitals. How do I submit Replacement Claims? Providers may submit replacement claims requests for originally paid claims. Billing days for a replacement claim is 180 days from the original billing date for Medicaid and State funded services. Please see the training webinar Alpha MCS Provider Portal Claims demonstration to show how replacement claims are submitted. This can be found on Eastpointe’s website located under the Alpha MCO System Information and Updates.

Re-credentialing- Please follow the instructions on list serv. You will not need to send the NPI letters or licensure. Eastpointe will verify this at time of review. If an LIP is associated with more than 1 provider, each provider will have to submit an application for that LIP. The LIP can make copies of the application and share with each provider to avoid filling out so many apps. The applications must be submitted to Eastpointe by the provider, not the LIP.

There is a moratorium on Letters of Support except for .3200 Social setting detox and .4100 Therapeutic Homes for Individuals and Substance Abuse Disorders.

Linda Hawley Isbell Director of Network Operations

If you need to change information in the Alpha system or the Provider Choice Database you will need to complete the Eastpointe Provider Change Form. We will not be able to accept an email or phone call to change any information.

You can locate this form on our website under For Provider Community and then Provider Forms.

You must complete section #1 and section #14 and then any other sections with information that needs to be updated.

Please note at the top of this form you can choose if the updates are for:

Provider Choice Database

Alpha

Both

Please remember that providers are responsible for keeping accurate information on the Provider Choice Database.

The Provider Choice Database is what the community and other providers utilize for choice of providers.

The Provider Choice Database is also where a member or their family member may go to locate the After Hours Crisis number for a provider.

Effective 2/2/15 we began our new process for reviewing requests to move or add a site.

The request must be: Sent in writing and signed by the CEO or designee.

It must state the effective date requested.

Must include the complete address for the requested location.

Adding a site is only for Outpatient sites if these services are already in your contract

Eastpointe will: Review the request for completeness

Conduct a Good Standing Review

If the Provider is in Good Standing an Onsite Review will occur

The provider will receive a letter indicating if the site has been approved

If a provider fails to follow the process indicated Eastpointe will:

Recoup any funds billed from the unapproved site and

All members would need to be offered choice of another site or provider.

Please note that we are not adding additional sites to Alpha other than approved sites to provide Outpatient Therapy.

If you see one of your already approved sites that is not showing up in Alpha please complete the Eastpointe Provider Change Form.

We have begun our Re-Credentialing process for all agencies, hospitals and Licensed Independent Practitioners (LIP’s) currently in our network.

Please note that our network is closed and we are not adding any additional agencies or LIP’s in private practice.

Any LIP who was credentialed by Eastpointe from December 31, 2014 through current do not have to submit a re-credentialing packet. They do not have to be re-credentialed at this time.

We are accepting all re-credentialing applications through email and mail through July 15, 2015. After that time only application that are scanned into pdf format and emailed to [email protected] will be accepted.

mailto:[email protected]

Only LIP’s who provide basic benefit outpatient therapy services covered under Clinical Policy 8C through their own contract or through an agency contract need to be re-credentialed.

If an LIP provides both basic benefit outpatient services covered under Clinical Policy 8C and other services they will need to be re-credentialed.

All Agencies must complete their Agency application as well as submit re-credentialing packets for all Licensed Independent Practitioners (LIP’s) as outlined in the previous slide.

LIP’s who have their own contracts must submit the complete LIP application which includes the Criminal Background Check Release, Attestation and application.

You can find the application packets by going to the front page of our website by clicking on the link for Re-Credentialing.

All applications must be submitted within the required timeframes to [email protected]


We will review each application when it is received. If there are missing items you will receive an Unable to Process Letter and be given 10 business days to submit the required information in order to process your application. If we do not receive the requested information in the required time frame then we will end processing.

A provider would have to submit a new application packet in order to start the review process after the process has ended.

If your agency or hospital name starts with A-F or you have an LIP Contract and your last name starts with A-F

You needed to submit your application packets to Eastpointe between

June 22, 2015–

July 10, 2015

If you have not submitted your applications yet you have missed the deadline.

If your agency or hospital name starts with G-M or you have an LIP contract and your last name starts with G-M

You need to submit your application packets to Eastpointe between

July 13, 2015 -

July 31, 2015

If your agency or hospital name starts with N-S or you have an LIP contract and your last name starts with N-S


August 3, 2015 –

August 21, 2015

If your agency or hospital name starts with T-Z or you have an LIP contract and your last name starts with T-Z


August 24, 2015-

September 11, 2015

Alpha will automatically discharge members in the following situations:

If a State insured member has not received an SA service in over 60 days from last claim date of services

If a State insured member has not received an MH service in over 180 days from last date of service

Karen Salacki Chief of External Operations

Please note that our Provider Network is closed.

We are not accepting any applications for State Funded Services.

We are not accepting applications for any enhanced services. We are only accepting applications for Medicaid services for the those discussed in the upcoming slides.

Eastpointe is accepting MCO applications from Hospitals.

Please contact Network Operations for the application packet.

For Agencies: An Agency can add Psychiatrists. You will need to submit an LIP application to [email protected] . The psychiatrist cannot provide services to Eastpointe members until the date that they are credentialed.

For Private Practice: Eastpointe will also accept applications from Psychiatrists in private practice. They will need to submit an LIP application to [email protected] .

mailto:[email protected]:[email protected]

Agencies can add an LIP to replace an LIP on a team that has left your agency.

Please submit on your letterhead to indicate which LIP is leaving that the new LIP will be replacing.

Please note that it is a requirement to notify us that an LIP has left your agency and when you hire someone to replace them. You also must submit a ticket to end their access to Alpha.

Additional teams for IIH, CST, MST and ACTT are not being credentialed at this time.

We are very interested in hearing from our Provider Community about topics that you would like us to discuss at upcoming meetings. We would like to make sure that we are covering topics of interest to our Provider Network. Please send those to [email protected] .

Please indicate in the subject line : Provider Meeting Topics


Critical information about updates and changes within our system our sent out via our listserve.

It is you as an independent practitioner or your agencies/hospitals responsibility to determine who needs to sign up to receive the important information that is sent out through listserve.

Just because you have not signed up for listserve does not mean you are not accountable for the information that is distributed.

Directions for signing up for list serve:

1. Go to Eastpointe’s website at http://www.eastpointe.net

2. Click on For Provider Community

3. Go to Provider Listserv, then click on Eastpointe Provider Listserv Sign-Up

Form

4. Enter your email address (make sure you type it correctly), enter your first

and last name, and agency

5. Click on the Sign Up button

6. After you sign up, a Thank you page will open. You have been added to the

mailing list and can exit

You will receive an email that your request has been submitted

Please remember to register for Provider Meetings on our website

Under Provider Community

Then Calendar of Events

Our next meeting is scheduled for August 19, 2015 from 10:00am until 1:00pm and this will be at the University of Mount Olive.

Website: www.eastpointe.net

Network Operations Call Center:

888-977-2160

Email: [email protected]

Fax: 252-407-2450

Member Call Center 800-913-6109

Fax: (910) 345-8971

eastpointe july 15, 2015 10:00am until 1:00pm webinar · if you send in the client update, please...

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