Tuesday, July 07, 2009

NC Medicaid Provider Enrollment : new private company! takes mental health provider information: DMA/EDS/ CSC in same mix

If you want to change anything about your provider status as a mental health provider accepting Medicaid in NC (DMS), note that EDS---- not any other entity---- is still doing this. (OH, EDS will send you the 'welcome letter': that's efficiency for you: one part of the Medicaid monies goes to EDS; one goes to CSC; one goes to the state; and who knows who else has their hand in the pie).

This new private company, CSC, does the provider enrollment management; another private company, EDS, tries to manage, some pieces (after waiting for 10 minutes, the CSC guy tells me to go back to EDS)......

So, I asked for the supervisor and he somehow came up w/ this link which is associated w/ EDS which of course is associated w/ provider enrollment matters (which CSC has been stated to manage): http://www.ncdhhs.gov/dma/forms/eft.pdf.

WHOOPEE! One hour on the phone and I get to the Electronic Funds transfer form.

Oh, and more information will be required of providers creating more work for mental health providers e.g., criminal background checks, etc.----yet more paperwork. (see below, FAQ).

And the payments are now irregular since CSC came online. No one at the EDS line (1 800 688 6696) knows ANYTHING about why this has taken place. For the past two years, when I would submit a very efficient webclaims payment request (easiest part of mental health billing), I would get paid like clockwork the following Wednesday when I submitted on the prior Thursday by 5 pm. This past submission, created on June 25, 2009, was not paid until today, July 7.


After April 20, 2009, a company (a large contract obtained by someone associated w/ NC Medicaid/ NC DHHS you can bet) called Computer Sciences Corporation is whom you need to contact.

You look at the NC website and you think, OK, part of state government. Nope. Behind the link (http://www.nctracks.nc.gov/) is a private company (remember: we're trying to strangle government so that we can pad private pockets).

The FAQ of the web site takes you to the information:

1. Who is CSC?

CSC is the entity that has assumed the Medicaid provider enrollment, verification, and
credentialing (EVC) activities previously performed by DMA Provider Services.

2. What is the EVC Call Center?
The EVC Call Center is CSC’s dedicated Medicaid provider enrollment, verification, and
credentialing center for providers to inquire on the status of their Medicaid applications
or change requests. The Call Center staff also assists providers with questions
regarding completion of enrollment and change forms. The EVC Call Center hours of
operation are 8:00 a.m. to 5:00 p.m., Monday through Friday, except for State approved

3. How can I contact the EVC Center?

Beginning April 20, 2009, you may contact the EVC Call Center as follows:
EVC Call Center Toll Free Number 866-844-1113
EVC Call Center Fax 866-844-1382
EVC Call Center E-Mail Address NCMedicaid@csc.com
CSC Mailing Address NC Medicaid Provider Enrollment
PO Box 300020
Raleigh NC 27622-8020
CSC Site Address NC Medicaid Provider Enrollment
2610 Wycliff Road
Suite 102
Raleigh NC 27607-3073
CSC Website Address http://www.nctracks.nc.gov

4. Where can I find more information about the new enrollment/credentialing
You can obtain information from the DMA website
(http://www.ncdhhs.gov/dma/provider/mmis.htm) as well as the CSC website

5. Where can I access applications for new enrollments?
Providers can continue to access applications from a link on DMA’s website at
http://www.ncddhs.gov/dma/provenroll/ or directly from CSC’s website at

6. Will the enrollment process change since there is a new vendor?
No. At this time the enrollment process will remain paper-based.

7. Can I complete my application online?
A web-based application will be available to providers in late summer of 2009. As this
date approaches, there will be more information available.

8. How long does it take to process a provider enrollment package?
Once a completed enrollment package is received in the EVC Call Center, it should take
approximately 2 to 3 weeks to process.

9. How will I know that my application has been received?
The receipt of your application will be acknowledged by e-mail or in writing.

10. How can I check the status of my enrollment package?
Beginning April 20, 2009, you may contact the EVC Call Center at 866-844-1113 to
check the status of your enrollment package.

11. How will incomplete applications be processed?
Whenever possible, CSC will communicate via e-mail if missing or additional information
is needed from providers.

12. How will I be notified once I am enrolled?
Once you have been approved for participation in the N.C. Medicaid Program, you will
receive a Welcome Letter from EDS.

13. What happens to an enrollment application that is submitted to DMA before
April 20, 2009?
All enrollment packages that are not processed by DMA prior to April 20, 2009, will be
screened for completion by DMA staff. If all information is complete the application will
be forwarded to the EVC Call Center for completion. If an application is incomplete it will
be returned to the provider to complete and send to CSC.

14. What happens to an enrollment application that is submitted to DMA after
April 20, 2009?
All enrollment packages that are received by DMA after April 20, 2009, will be forwarded
to the EVC Call Center for completion.

15. Will existing Medicaid providers be required to re-enroll?
No. However, CSC will verify information in the Medicaid provider file and will credential
providers who have not been not credentialed in the last 14 months.

16. As a currently enrolled provider will I be required to complete a new or additional
enrollment application?
No. However, each provider must verify information in the Medicaid provider file and
furnish additional information on ownership and criminal background as required by
Federal and State regulations. CSC will notify each provider prior to initiating the
verification and credentialing process and will request providers to complete and return
the forms within 30 days.

17. Will DMA allow providers that are credentialed by other agencies to be
grandfathered and avoid credentialing by CSC?
No. DMA has determined that other credentialing agencies do not collect all required
information needed to satisfy all federal and state requirements for Medicaid enrollment.
Since CSC will source verify the credentials of providers, providers will not be required to
submit copies of licenses, certifications, accreditations or endorsements.

18. Will my Medicaid claims payments be impacted when CSC begins processing
applications on April 20, 2009, or when CSC begins verifying information for
currently enrolled Medicaid providers?
No. There will be no impact to claims submitted to EDS for processing and payment will
not be impacted. EDS will continue to process all Medicaid claims until August 2011


Right now, I am sitting on a 10 minute plus hold waiting to find out where the 'change of banking information Electronic Funds Transfer ' form is.

Given that it took CIGNA Government Services 6 months to change my address about 1.5 years ago, I figure this will (NOT) be a snap.

There will be little success as associated w/ mental health care in terms of efficiency until there are efficient systems undergirding authorization/ utilization / billing.

Some investigative reporter should figure out who got them the contract.

WAIT! WAIT! Someone answered the phone. He did not identify his name (always get the name). The information about the Electronic Funds Transfer is not on the NC Tracks website, he says. OH: you need to contact EDS.

I'm contacting Rep Verla Insko & Martin Nesbitt, co-chairs of NC mental health reform committee.

Friday, July 03, 2009

CIGNA: 19.1 BILLION Sales in 2008: CNN: Former CIGNA VP/ exec outlines how insured are 'purged' from being insured

"Potter (a Vice President at CIGNA) started thinking about leaving CIGNA in 2007 after he visited a medical charity event at a Virginia fairground. 'It was almost like an electrical jolt,' Potter said. At the event, Potter took pictures of doctors offering free 'health care' to the uninsured. 'The volunteer doctors were seeing patients in barns, people in animal stalls,' Potter said. 'It changed it for me.'

HERE is Potter's blog on health care reform: http://www.prwatch.org/blog/35267

BCBSNC has been giving out free generic medication for the past six months. This practice stopped on July 1, 2009.

NC Psychological Association encourages psychologists to give 'free' depression assessments during certain times of the year.

Sorry: but the providers need to be paid and the patients need to be properly cared for and NOT utilizing some jump and start system smacking of Animal Farm.

BTW: It is CIGNA GOVERNMENT SERVICES that administers MEDICARE at this time for: ID; TN; NC.

It took me SIX MONTHS to get my billing address changed w/ them about two years ago.

So, you see, what 'looks' like Medicare right now is not Medicare in terms of all the little CIGNA's around the country. Whopping article here for some diligent writer.


(Note: 'revenue' = 'sales' in the article below: http://www.msnbc.msn.com/id/7477449/)

Ex-executive accuses insurance giant of 'purging' customers

Wendell Potter says insurance companies only out to please Wall Street investors

By Jim Acosta and Bonney KappCNN's CNN American Morning

PHILADELPHIA, Pennsylvania (CNN) -- Wendell Potter says he is finished defending the insurance industry, which he says is "beholden to Wall Street."

Wendell Potter once was a vice president in the public relations department for insurance giant Cigna.

At a hearing last week before the Senate Commerce Committee, the former vice president of corporate communications at the insurance giant Cigna testified, "I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry."

The committee's chairman, Jay Rockefeller, D-West Virginia, told Potter, "You are better than Russell Crowe on 'The Insider,' " referring to the award-winning 1999 film about cigarette company executive Jeffrey Wigand, who blew the whistle on the tobacco industry's practices.

In his testimony and during an interview with CNN, Potter described how underwriters at his former company would drive small businesses with expensive insurance claims to dump their Cigna policies. Industry executives refer to the practice as "purging," Potter said.

"When that business comes up for renewal, the underwriters jack the rates up so much, the employer has no choice but to drop insurance," Potter said.

CNN obtained a transcript of a 2008 Cigna conference call with investors in which company executives use the term "purge."

But in an e-mail to CNN, Cigna spokesman Chris Curran denied the company engages in purging.
"We do not practice that. We will offer rates that are reflective of the competitive group health insurance market. We always encourage our clients to compare our proposed rates to those available from other carriers," Curran wrote.

Cigna had revenue of $19.1 billion in 2008, according to the company Web site.
Potter started thinking about leaving Cigna in 2007 after he visited a medical charity event at a Virginia fairground.
"It was almost like an electrical jolt," Potter said.
At the event, Potter took pictures of doctors offering free health care to the uninsured.
"The volunteer doctors were seeing patients in barns, people in animal stalls," Potter said. "It changed it for me."

He says he finally decided to quit in 2007 after Cigna's controversial handling of an insurance claim made by the family of a California teenager, Nataline Sarkysian.

The Sarkysian family made repeated appeals at news conferences for Cigna to approve a liver transplant for the 17-year-old, who had leukemia. Cigna initially declined to cover the operation, then reversed its decision.

Sarkysian died hours after the company's reversal.

As Cigna's spokesman during the controversy, Potter had no role in the decision to deny coverage. But he was inundated with angry phone calls.

"After she died, my voice mail and my e-mail inbox were just filled with messages from people who were just outraged, " Potter said.

Don't Miss
In Depth: Money and Main Street
Potter's blog
Now a senior fellow on health care for the nonpartisan watchdog group Center for Media and Democracy, Potter writes a blog on health care reform. In particular, he is keeping an eye on efforts to defeat legislation that would give Americans the option of joining a government health care plan, something he now supports.
He says he witnessed how the insurance industry torpedoed health care reform efforts during the Clinton administration.
"They conduct what I call duplicitous PR campaigns. They'll say what people want to hear," Potter says. "It's how they operate. You cannot trust these guys."
Potter is also taking aim at some of the TV commercials aired by groups opposed to changes. One such ad caught Potter's eye. Run by the conservative organization Patients United Now, the ad says that "now, Washington wants to bring Canadian-style health care to the U.S."
"Sometimes you'll see misleading information. And sometimes you'll see outright lies, like that [ad] is," Potter said, referring to the spot.
Patients United Now spokeswoman Amy Menefee disagreed.
"We're not saying there's a Canada health care act of 2009," Menefee said. "It is a trend. It's trending in that direction."
Potter notes that the leading proposals for health care in Congress do not seek to set up Canadian-style health care in the United States. He says claims that overhauling the system would lead to "rationing" of care are missing his point.
"What we have is rationing by corporate executives who are beholden to Wall Street. And it happens all the time," Potter said.
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Wednesday, July 01, 2009

Homeless people in the libraries of Buncombe County: don't look like you're sleeping or have a mental illness

Many people w/ Severe Persistent Mental Illnesses take medications which cause them to feel drowsy during the day (no, that's not me):

Dear Mr. Sheary, Director of the Buncombe County Library System: Ed.Sheary@buncombecounty.org

Thank you for your reply.

I was not asking for preferential treatment and I was not suggesting that you turn the downtown library into a day shelter. There is a day shelter within one-half mile of the downtown library.

I was asking that my tiny little bit of private space between my face and my laptop be respected.

I am reminded of the German expression, 'Work Will Make You Free' over the gates of the Dachau concentration camp.

The library's motto might be: 'Sleeping Will Cause You to Get Shaken.'

May I ask who are the members of the Board that oversee the Buncombe County Library System?

As a psychologist, I have homeless clients that live in Asheville that only want a tiny bit of space for their own and will put up with a great deal in order to have this.

They are thrown out of The Mission early in the morning and roam the streets or hang out until the day shelter closes at 5 around the corner from the Salvation Army.

The Family Care Homes, which provide them w/ food and lodging, for 95% of their disability checks, are grungy, boring existences.

I quite understand that Asheville believes it has an agenda to 'make it look good for the tourists' and I am not opposed to that matter.

However, I do not believe that applies to my tiny personal space.

I'll be following this up, Mr. Shearing. Forward this to anyone you like.

I'm submitting it to the Mountain Express as an Opinion piece. Look for it. And I will contact the ACLU.

marsha hammond, phd
Here is the letter from Ed Shearing who directs the Buncombe County Library System:

At 01:35 PM 7/1/2009 -0400, you wrote:

Dear Dr. Hammond: The Library Rules of Behavior are posted at the building's entrance.

The no sleeping statement is the second item on the list.

Informing patrons of this rule is actually the most effective tool we have for keeping the library from becoming a day shelter.

I am sorry you are displeased with this, but I am sure you understand that the library staff must and will apply policies in an equitable manner to all patrons.

Sincerely, Ed Sheary

From: hammondmv@netzero.netSent:

Wed 7/1/2009 1:25 PMTo:


Cc: steve.fazio@buncombecounty.org (security guard at the downtown Buncombe Library):

Subject: query fm dr. hammondMarsha V. Hammond, PhD Clinical Psychologist,

RE: security guard Steve Fazio shaking me out of my chair as I was resting my head on my laptop

July 1, 2009Dear Mr. Sheary:

I seldom come into the Buncombe library downtown. I do find the reference librarians to be helpful and the environment conducive to work when I am downtown w/ my laptop.

In my undergraduate college days, I would, when tired, lay my head down on my books in the library so as to awaken refreshed to continue my task.

RE: this matter, Mr. Sheary, I would like to know why the security guard, Steve Fazio, shook my chair and demanded 'no sleeping in the library' today, July 1, at approximately 12 noon.

I can understand that the library system does not want loiters laying on the floors but I really believe that if people want to lay their heads down on their books or purse that they should be left alone.

I would, accordingly, like a copy of the library policy pertaining to 'sleeping' and what constitutes 'sleeping.'

I can imagine that many homeless people who get chased out of The Mission less than a mile down the street, or the Salvation Army, or any other homeless shelter, feel intimidated by someone shaking their chair.

I would like an explanation, please, Mr. Sheary. Forward this to anyone you like. Marsha V. Hammond, PhD