Monday, November 08, 2010

This is Why Outpatient Mental Health Has Fallen Apart in NC: Splitting up the Duties of Medicaid Authorizations/ Payments

Post Script #8, Friday pm, November 19, 2010: I talked to Monika at HP Enterprises yesterday and she faxed to me a form which allows me to pay $4.90 for Remittances so that I can see what errors (there are commonly errors) on my Medicaid billing which I can address and resubmit. Instead of HP making the Remittances handily available on the NC Webclaims website, and having the form demanding (in my case, a whopping $4.90, 35 cents/ page) the payment interfacing efficiently on the NC DHHS/ Medicaid 'Basic Medicaid Billing' website----one has to spend hours going back and forth between Amy and Monika of HP Enterprises in order to get a few pieces of paper in order to fix the billing. But FIRST you would have had to turn up the telephone number and the appropriate people with whom to talk. So, all this took me several hours not to mention the work on the end of HP. Very efficient, NC Medicaid. This is why outpatient mental health is rolling over and (not pretending to be) dead in NC. ARRGH.

Post Script #7, Thursday am, November 18,2010: there is a mismatch between the information re: Remittance documents at NC Medicaid & what the billing company, HP Enterprise states; this is a note to NC Medicaid Behavioral Health Section employee, Katherine Nichols: "Hi Ms. Nichols: I am sorry to be such a pest. However, basically, the information at HP Enterprises and what the NC Medicaid online information does not match. (see below) . This being said, when she transferred me to the extension of the woman at HP Enterprises, Monika, whom was obviously, per her voice mail, responsible for remittances beyond the 'last 10 billing cycles' of Medicaid, there is absolutely no information about how the requesting provider is supposed to pay the 35 cents/ page. Do you know? Moreover, in looking at the NC Medicaid 'Section 9. Remittance and Status Report' pdf, under 'Basic Medicaid Billing Guide' which is the responsibility, I guess, of NC Medicaid, under the section, How to Request a Duplicate Remittance and Status Report', it states: "Providers may contact HP enterprise Services Provider Services for a duplicate copy of an RA. Guidelines vary according to the timeframe of the request. RAs within10 checkwrites (one is issue every week, BTW---as you know----I put this here because this info is going on my blog)...... will result in a charge per page. Timeframe of "10 checkwrites" is determined by the date the RA request is received by HP Enterprise Services Provider Services. Note: All duplicate RA requests will be mailed to the provider. Routine business operations do not allow HP Enterprise Services Provider Services to fax or e mail RA requests." HOWEVER, as per the RA woman at HP Enterprise, she wants to FAX the information as this is what her voice mail asks for. I don't use faxes for the most part, so I gave her my address. Pt #1: the information at HP Enterprises and what the NC Medicaid online information DOES NOT MATCH. Pt #2: How is HP Enterprises supposed to get their 35cents / page for older RA's? there is no info about how to do this. It seems amazing to me that such a company would expend energy to recoup a few cents, frankly. I'll give it a week and see if the RA (I requested two of them) will come to me. Then I will call you back. Pass this to any salient party. Sincerely, Marsha V. Hammond, PhD"

Post Script #6, Tuesday (same day, at 10:20 am or so) received several calls, e mails, from Behavioral Health section and one from Amy of HP Enterprises informing me that only 10 of Remittances (information indicating how claims were handled,whether paid or not and codes as to any problems) were available 'free of charge' and after that they are '35 cents/ page' which I indicated I would pay. She then shuttled me to an extension for Remittances where there was a message machine asking for detail information and declaring that some response would be made available 'within 24 hours.'

Post Script #5, Tuesday (same day, at 9:38 am) calling the Behavioral Health section of NC Medicaid at 919 855 4290, the message machine states: "Sorry, the number you have called is either busy or......BEEEPPP."

Post Script #4, Tuesday (a week later, 11.16.2010), calling Amy of HP Enterprises, tel 919 816 3063, whom is reportedly contact for Medicaid Remittances (records of billing submitted which was made electronic by HP Enterprises beginning in July, 2010), as she has not responded after three telephone calls to make available remittances at the NC Medicaid Webclaims website where all billing is done. I'll be calling (again) NC Medicaid and then at the end of the day, Mr. Cansler's office.

Post Script #3, Tuesday am and afternoon, 11.9.2010 (funny how cc'ing Lanier Cansler, NC DHHS Secretary, will get you calls back on your billing and authorizations from the various companies associated w/ billing): Nice people from HP Enterprises (yes, that's Hewlett Packard) called looking over remittances which I have yet to get to. They can see the info but I, the provider, cannot (remittances are feedback on billing which HP electronicized, so to speak, creating additional barriers to mental health providers being able to see what is going on with billing). Additionally, one person from Behavioral Health unit called me twice today in order to see if things were being followed up re: my questions.....will keep you posted about further problems w/ the various bits and pieces of NC Medicaid laying everywhere, in every direction OR as Amy from HP Enterprises (which does the billing for NC Medicaid) said: "It was hard for providers when Medicaid was privatized....."

Post Script #2 at 3:30 pm 11.8.2010: I have sent an e mail to Lanier Cansler as the Behavioral Health Unit personnell are unable to answer the below questions. I am sorry to be so obnoxious, but the last time I asked one of them, Peter Bernadini, a question via e mail, it was over two weeks when he got back to me; by that time I had gotten an answer from the helpful Bert Bennett. Bert Bennett was on vacation last week and he is on vacation today and it appears that whether you call the Behavioral Health Unit, which I have 3x today, or if you send e mail, you still cannont get an answer. It would appear to me that you can't run a division of NC DHHS if only ONE person knows the answer to questions which are pressing outpatient mental health providers who are trying to keep people 'out of the ditches.'


Post Script # 1 at 10:30 am, 11.8.2010: After sending Bert Bennett of NC DHHS the following e mail, I called the number he gave me, which is for the Behavioral Health Unit of NC DHHS at 919 919 855 4290. The message on the machine (not even any options) was: "Sorry, but the number you have called is either busy or not available. Please leave your name." BEEEEEEEEEPPPPPP

I'll be calling Lanier Cansler, Secretary of NC DHHS, this afternoon if I don't hear something from these people.

In Texas, they are considering just ridding themselves of Medicaid, since the Republican got elected to governor. While I did my PhD there, I am sure glad I don't live in that godforsaken place.

In NC, this is part of the reason why Outpatient Behavioral Health (read: mental health) is falling apart. Here is my letter to a person whom has generally been helpful at NC DHHS, Bert Bennett. This being said, with all the pieces of NC Medicaid scattered to the winds, it is no surprise that these kinds of problems exist. Here is my letter sent today:

Marsha V. Hammond, PhD Clinical / Health PsychologyNC Licensed Psychologistcell: 828 772 No Faxe mail:

November 8, 2010

Hi Wendy Korb & Bert Bennett of NC DHHS Behavioral Health Unit
Thank you for assisting me.

I sent Bert an e mail last week asking about the matter of filling out the ORF 2 form (which authorizes providers to render outpatient behavioral health after the first 8 sesssions every calendar year) which, I assume, wraps around----necessarily-----to the NC Webclaims billing page as regards the matter of the terms 'attending/ referring.'

This being said, I am not being paid for authorizations which were in place as of April, 2010, for a number of clients and I am having a hair-pulling time simply getting remittances. Today, I talked to Margo at HP Enterprises to find out that there are two log on numbers associated w/ my name, Marsha Hammond, PhD. She apparently corrected that and I have logged back on using a new password. I have no idea if this has anything to do with not being paid. I am exasperated to say the least.

HERE are my TWO questions to you, Bert, and Wendy, whom you referred me to, Bert, as you were out of the office some last week:

ON the ORF 2 form, and as per the directions online at NC DHHS, and as I understand it, when I fill in the line which states:

Attending Provider Name/ Medicaid # I AM supposed to fill in (which I faxed on Saturday a large set of ORF 2 forms as I am not being paid, not receiving remittances, and can in no way figure out what is going on):

"Marsha Hammond PhD --------- LP # 2748" (it is HARD to get all this on that line as demanded by the directions)

Then the next line which states, Billing Provider Name/ Medicaid #, I have filled in:

"Marsha Hammond PhD -------------"

***********************Is this CORRECT?

Then, in terms of wrapping around to NC Webclaims billing, in the section on the CMS 1500 claims form, which I have been filling out for years, and only since HP moved into NC DHHS billing as well as the general dismantling of the entire NC Medicaid authorization and billing system have I had these massive problems, this is what I fill in:

1. the information about the provider at the onset of the claims information
2. I also fill in the Rendering/ Attending provider information as THIS IS WHAT THE ORF 2 FORM TELLS ME TO DO.

*****************Is this correct?

Pass this to anyone you like but I need an answer quickly.

I am looking forward to getting my remittances dating back to July, 2010, as today I talked to the remittance people (yet another piece lost in the system) which has demanded that behavioral health providers fax in a special form----a service which WAS IN PLACE prior to HP Enterprises being contracted w/ NC DHHS as associated w/ Behavioral health.

Sincerely, Marsha V. Hammond, PhD


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