Friday, June 15, 2012

Medicaid Waiver under SMC LME: Does Anyone Know How to Get in Touch w/ People Writing the Mercer Report Overviews of the LME's?

Here is recent correspondence between myself and an official, with an unstated job title, at Smoky Mountain Center LME.  Oh, and by the way, the Medical Director of SMC LME never contacted me. :


Dear. Mr. Martin:

May I ask what your position is at SMC LME?

AS re: your below e mail indicating that 'many stakeholders' engaged in the credentialing process, did you ever ask any provider(s) about credentialing at all?
Or are providers not a 'stakeholder'?

I would like to know the answer to this question, if you would. I want to know if providers advised you that it was necessary to ask for 'Official College Transcripts." And I want to know how it is that up and down the chain of command of DMA, including you, the LME, not one person remembered that CAQH was a credentialing process already in place that providers have engaged in for years-----when it was stated by DMA to be a possible avenue.

Why are your organizations so slow? Millions of Medicaid $$ are being used up re: man/ woman hours processing piece by piece these credentialing applications---all asking for slightly different versions from the a la carte menu created by someone, somewhere, in DMA.

I believe that any provider who was a professional would have advised you that asking for the "Official College Transcript" was pointless as one's licensing board would have already have reviewed that matter.

You may think I am making a pretty big deal of this but the fact of the matter is, is that your LME has hundreds of provider credentialing packages to address in less than 2 weeks.

And according to the Mercer Report you were supposed to have been fast-tracking that matter. And you were behind in April, 2012, according to the Mercer Report.

But instead, what I get, is non-responses to my questions. So, somebody/ somewhere, perhaps as associated w/ my blog, will know how to get in touch w/ the people who do the Mercer reviews and I will tell them just how your credentialing process is going so that they will have some data from some entity other than the LME who undoubtedly paints a cherry picture of things.

You're failing at your credentialing. WHN LME failed/ is failing at its credentialing process.  They can't even keep my pieces of paper together but lose them and ask for them again.  If you were using CAQH, none of this would happen.  And it would all be paperless. 

I still have no response from the Provider Relations Department, either by e mail or phone (I approached it from both of those) and it is 3 business days hence.

I will fax to my doctoral degree university, University of North Texas, which is clearly indicated at CAQH and probably at the NC Licensing Board website, a request for an Official College Transcript so that my package will be complete. And I will go over and ask Matt Holmes, MD, psychiatrist of the ACT team, and Sandy Howard, PNP, for letters of reference. I have no psychologists to ask as there are no psychologists working under SMC LME catchment area that I know of.   

Feel free to pass this e mail on to anyone you like.  Its on the public domain at my blog, in any case.  My intention is to documents for providers and reporters and anyone else who is concerned, just how badly this Medicaid Waiver matter is going. 


Marsha V. Hammond, PhD

cc: DMA ; blog

On Thu, Jun 14, 2012 at 8:25 PM, Craig Martin wrote:

> Good evening Dr, Hammond.

> Thank you for taking the time to reach out to us about the way credentialing has been so problematic for our network LIP's. I do apologize  to you for this.

 As I imagine you've heard from others, it took work on the part of many stakeholders to move to more standardization by LME/MCO's in the credentialing process.

> SMC's LIP's will benefit from this in the future.....and I regret the approval for  this change came so late in the game.

 I spoke with Dr. Wilson who has contacted you today.

Thank you for your patience as we work to implement the changes in Medicaid benefit management that will over time help improve provision of needed services for those we mutually serve.

> Kind regards,

> Craig


> Sent from my iPhone


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