Sunday, June 24, 2012

Now, Late in the Day, the Director of Provider Relations at SMC LME, Indicates that the Re-credentialing Materials from WHN LME Can be Used for Recredentialing w/ SMC LME

The following is correspondence between myself and Patty Wilson, Director of Provider Relations at SMC LME:


Dear Patty Wilson, Director of Provider Relations at SMC LME:

I appreciate your note. It does not help, however, that you are now directing me to change the materials you have insisted I submit as per your 'check-list' at this late stage of the game.

As per your demand on your check list, I have already sent off for my 'Official College Transcript' and will be submitting this to the SMC LME Provider Relations Department---as you requested on your official check-list. A point to be noted: there will be no Licensed Independent Practitioners who will not have gone thru credentialing / licensure processes that would have required this and so WHY did you ask for this to begin with? Did you now think thru this matter?

Additionally, it does not make any sense to have two separate provider credentialing application processes as per WHN and SMC LME. How is it that your two LME's are able to pull up an a la carte menu of things that you demand from LIP's? ---that are completely different?.

As you have alluded to below, I 'may'---as you say----- send my WHN LME application to SMC in lieu of what SMC has asked for. However, I frankly would not trust that this would suffice given the difficulty I have experienced in getting some word----from you-----that this could be so.

And as you know, we are up against your July 1, 2012 deadline .

Is there no standardization of this re-credentialing process for Licensed Independent Practitioners or do we have to clue you----the Provider Relations Departments----as to what makes common sense?

You seem to be inferring that I do not need to send in to the two 'letters of recommendation'p; however, I have already obtained them. And so, it is late in the day for you tell me that I can now just use the WHN LME credentialing process which does NOT require the two lettters of recommendation.

Didn't any of the LME's THINK about this process prior to demanding providers to do all this work? Didn't any of the LME's standardize this re-credentialing process, using the CAQH credentialing process, for example, which NC DMA has suggested to begin with?

I find it distressing to think that most of the Medicaid money is being spent on recreating the wheel over and over again rather than being applied to the needs of Medicaid recipients.

I am afraid that I do not trust that if I send in my SMC LME re-credentialing application which is to have included:

1. CV
2 two letters of recommendation
3. 'official college transcript'

----a process which is completely different from that of WHN LME----- that I will get anything back but a certified letter that you have not received the correct materials---even though you suggest that the materials for re-credentialing for WHN LME is the same as that for SMC LME.


Thanks again, for your reply, Ms. Wilson, but I am sending in to SMC LME what your official check list has stated I must send in.

I don't trust anything else given the difficulty in working w/ SMC and WHN LME regarding this Medicaid Waiver re-credentialing process otherwise.

Marsha V Hammond, PhD
On Thu, Jun 14, 2012 at 4:29 PM, Patty Wilson wrote:

> Dear Ms. Hammond,

> Thank you for your request for information/clarification regarding required elements of the LIP application.

> I am sorry you were unavailable to receive my two phone calls yesterday (6-13-12), or my phone call today. As I indicated in my voicemail to you today, in follow up to the two yesterday, I am responding by email.

> Your point that transcript submission is redundant since you are already licensed is well made. As such, please feel free to omit that document from your application when it is submitted. Additionally, in terms of standardization, you may simply make a copy of the application you submitted to Western Highlands Network, and send it to the Provider Network Department at Smoky Mountain Center. The only caveat is that original signatures are required at points of signature.

> Our records of paid claims for behavioral health services for consumer's whose Medicaid originates in the SMC catchment, do not include payments to you. We know that these records can be incomplete. Remittance Advice documents of paid claims to you, for services rendered since January 1, 2012 to SMC consumers, may be submitted as proof that you have provided such services in the timeline specified for admission to the SMC Network. Please be sure to conceal any Personal Health Information if you submit such documentation.
> Again, thank you for your inquiry. If I can be of further assistance, please do not hesitate to contact me.

> Thank You,

> Patty


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