Tuesday, June 12, 2012

Under Medicaid Waiver, Western Highland Network's Piecemeal Provider Application Process

FROM: Marsha V. Hammond, PhD Clinical / Health Psychology NC Licensed Psychologist cell: 828 772 1127 e mail: chomskysright@gmail.com

TO: Sonia Etheridge and Kelly Stein, Provider Relations, Western Highlands Network LME-MCO e mails: burg0806@westernhighlands.org, "Sonia Etheridge"

DATE: 6.12.2012 RE: Licensed Psychologist "Provider Enrollment Application Request Forms."

Dear Ms. Etheridge and Ms. Stein:

Thank you for reviewing this application. I am a frank person and I try to operate as efficiently as possible, something I know you can understand re: mental health services. I am a solo doctoral level psychologist who provides therapy and assessment only. I specialize in working w/ people having SPMI, in particular personality disorders and DID.

I understand as per the administrative assistant with whom I just spoke, that you are on a rotating basis as regarding Provider questions and since Ms. Stein is already gone from WHN for the day, and since Mr. Etheridge is on tomorrow, I am sending you both this e mail and its attachment. You already have several of the documents requested as per this "Provider Enrollment Application Request Forms. " I describe in detail below that matter.

I have been a Medicaid provider in NC for over 10 years. I do not have a lot of Medicaid clients in Buncombe county but I am now about to move into that zone past the 8 unmanaged sessions and I know I will need authorization to continue to see them and be paid. I expect to be paid for the 8 nonmanaged sessions as I have always been paid in the past by the vastly more efficient webclaims billing process and authorization process that was in place prior to this Medicaid waiver.

Besides all of this, SMC LME is going under the Medicaid waiver knife also and I am filling out all of these papers at the same time. Moreover, I intend to expand seeing Medicaid clients under WHN LME. Therefore, I am filing to become an In Network Provider.

My understanding, as per my biller, is that I will be assigned some kind of number which will be included in billing. Prior to the Medicaid waiver, I did not have my biller do my Medicaid billing as I could efficiently do this at the webclaims DMA site. Now, I am resigned to creating these extra steps and so the purpose of my letter here and the attachment is to MAKE SURE that you have all the information you need from me.

It took me weeks back in January/ February, 2012, to get a reply from Melissa Faulkner who is, I am advised, the person to go to re: provider relations applications. She advised me in January/ February, 2012, to send her the following items, which I did at that time (she did not direct me to this "Provider Application Form" but instead indicated to me that because I had missed the January 3, 2012 deadline that I needed to send her the following items: 1. my tax return (I did) 2. a statement of my Emergency Response System (I did) 3. a list of all my Medicaid clients (I did). I assume that this Item 3 is what you need re: 'Market Analysis.' Thus, you already have that information which is being requested as per this "Provider Enrollment Application Request Forms.".

I anticipated that there would be another pile of paperwork forms to send in after that---and I did not have the time for that----- and so I have finally carved out time to do all of this and thus the lapse between February, 2012 and now. I do not believe that Ms. Faulkner requested the face page of my malpractice insurance policy and so I am sending that, along w/ my signed "Provider Enrollment Application Request Forms" to you both, in the US Mail.

I am puzzled by all these hurdles to simply continue doing what I have been doing for years. I would have anticipated that this "Provider Enrollment Application Request Forms" would ask for my malpractice policy face page but I guess there is yet another step re: this provider enrollment vis a vis WHN LME-MCO.

In other words, your system is extremely fragmented and therefore frustrating to providers.

Please do not send me to Ms. Faulkner to complete this process as we do not work well together. She is the one who just sent me the link as indicated above which did not open. Neither do the 'Directions" for this "Provider Enrollment Application Request Forms" open at the WHN website. I tried again just now: it still does not open. Moreover, in February, 2012, I had to utilize Nettie Jones on the WHN LME Board, the Buncombe representative, to get Ms. Faulkner to respond to my queries re: all of this.

I assume that the purpose of all this is in order to discourage providers from applying to the WHN LME-MCO network as you deem the deadline to have passed when in fact, NC DMA indicates that the deadline is to remain open 'for at least a year.'

Please let me know if you need anything else from me. I have enclosed the "Provider Enrollment Application Request Forms" which I filled in online------so that you can review this and tell me if anything is missing .

Again, I will be sending both of you, in the US Mail, my signed copy of that form along with the face page of my malpractice insurance. And, as outlined above, you already have all the other items which I sent to Ms. Faulkner in January/ February, 2012.

Thanks for your hard work. Sincerely, Marsha V. Hammond, PhD


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