Thursday, June 14, 2012

To the Medical Directors of Western Highlands Network and Smoky Mountain Center LME's: Please allow Licensed Providers to Use What Already is in Place & STOP RECREATING THE WHEEL

FROM: Marsha V. Hammond, PhD  Clinical / Health Psychology  NC Licensed Psychologist

cell: 828 772 1127  e mail:

TO: Medical Directors of SMC and WHN LME's

RE: credentialing boondoggle at both LME's re: Medicaid waiver: CAN WE PLEASE USE THE CAQH CREDENTIALING SYSTEM as recommended by your own DMA?

Date: June 14, 2012

Dear Dr. Stein (, Medical Director for Western Highlands Network LME and Dr. Patty Wilson, Medical Director for Smoky Mountain Center LME:

Why recreate the wheel over and over again, LME by LME, across the state, in terms of credentialing if there is already something in place? Your own DMA has recommended the use of the CAQH credentialing process. All the providers have submitted all the information you need to CAQH----YEARS AGO.

There is a July 1, 2012 deadline for credentialing for SMC LME. Thus, my questions. The credentialing process for both LME's is unweildy, has different requirements, requires 'Official College Transcripts', letters of reference (for one, not the other LME), tax returns (for one, not the other LME), etc. It is very obvious that the entire credentialing process is a complete mess: I seldom calls returned from Provider Relations; I get no answers to my e mail; I cannot turn up a live person when I call.

Under the Medicaid Waiver, your credentiailing process IS NOT WORKING.

As you know, I spoke with Dr. Lekwauwa who is in the Mental Health Division of DMA this afternoon. She indicated to me she would speak with the medical directors of both LME's to see if we can't cut to the chase here re: this vastly inoperable credentialing process w/ both these LME's re: Licensed Independent Providers (LIP) who have been Medicaid providers FOR DECADES.

All LIP's utilize the CAQH credentialing system which is demanded by other insurance companies. DMA, according to its web page, is interested in utilizing CAQH for credentialing.

Here is the CAQH web page:

Here is what the DMA webpage states:


LIP (Licensed Independent Practitioner) Credentialing

As noted in the last March Special Medicaid Bulletin, LME-MCOs have been working with
stakeholder groups on streamlining the enrollment process. As of this date, the following LMEMCOs will be using the Council for Affordable Quality Healthcare (CAQH) to gather credentialing data for Licensed Independent Professionals (LIP):
• CenterPoint Human Services

• CoastalCare (Southeastern Center and Onslow Carteret)

• The Durham Center/Cumberland/Johnston/Wake


• Partners for Behavioral Health Management (Pathways, Crossroads and Mental Health



• Sandhills

• Smoky Mountain Center

• Western Highlands Network

DMA will publish updated CAQH information as other LME-MCO make decisions about
working with enrollment and credentialing vendors.

The contracts between CAQH and the LME/MCOs listed above are being currently developed.

Future Medicaid Bulletins will notify providers when they can begin using the CAQH on-line enrollment process.

CAQH provides a streamlined, secure method for electronic data collection – at no cost to the
provider. Providers keep total control of the data, authorizing access only to the participating
LME-MCOs of their choice. Revisions made by the provider are available instantly to
authorized LME-MCOs.

CAQH is a national provider credentialing process that providers update every 3 months. As associated with that process, the CAQH people had to have received one's licensing information, etc.

Do you really want the entire batch of NC LIP's to have to complain about this impossible credentialing process which has been hoisted by the LME's undergoing the knife of this Medicaid Waiver?

Do you really want Medicaid patients to be without care----in the hospital, spending Medicaid dollars because the LIP's could not get their paperwork thru the LME's? Because this is what is going to happen and HAS been happening.

Do you really need to spend all the administrative $$ that the LME's are utilizing to put into place each LME's credentialing process when there has been one in place for years, namely, CAQH?


Marsha V. Hammond, PhD, Licensed Psychologist, NC


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