Monday, July 02, 2012

Medicaid Waiver: Smoky Mountain Center LME Cannot Efficiently Process my Request for Re-certification as a Medicaid Provider Because They Have no Ability to Ascertain if I Have Been Paid for Seeing Medicaid Patients Under Their Catchment Area, Even Given my Medicaid Provider # and Even Though They Administer Medicaid

I have noted the HIPAA tag at the end of Ms. Barlow's e mail which states:


"Pursuant to NC G.S. 132-1, any email sent to and from this email account may be subject to the NC Public Records Law and may be disclosed to third parties.
Pursuant to HIPAA Regulation 160-160.514, this email message is intended only for the use of the named addressee and may contain information that is confidential or privileged. If you are not the intended recipient, or you are not the employee responsible for delivering the email message for the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this email message is strictly prohibited. If you have received this email message in error, please notify the sender immediately"
There is no confidential patient information as associated with her e mail; therefore I am posting this in order that other providers, news media sources, and concerned citizens regard the difficulties of working w/ NC Medicaid, specifically as associated with mental health, under this Medicaid Waiver which has required that the LME's e.g., Smoky Mountain Center LME, Western Highlands Network LME, re-certify already certified Medicaid Providers.

.Here is my conversation with the recipient of my 40 pages of Provider Recertification information which came to her office today.  Apparently, SMC LME, though they are the administrators of Medicaid, has no ability to tell if Medicaid has paid me for services rendered over the past 6 months as associated with the SMC LME catchment area.  I find that amazing.
Here is my e mail to Ms. Barlow, processing the re-credentialing papers for already in place Medicaid providers:

Thank you, Ms. Barlow, processor of Provider Credentialing paperwork, as per Smoky Mountain Center LME, for your e mail.

I do not seek to be a contrarian; rather, I want to work smoothly with organizations who can organize themselves efficiently.

The item that you are asking about, specifically "SMC does not show (that you have) billed Medicaid on any SMC consumers within the last 6 months"----- is not on the checklist provided by SMC LME as being associated with what you demanded re: re-certification of Medicaid providers. I do recall reading something about that somewhere in the SMC LME provider re-certification information but no, it was not on your checklist as associated with items that MUST be submitted.

I would like to know why SMC LME cannot obtain from NC Medicaid, information about me, a Licensed Psychologist, with a Medicaid number, as having seen and been paid by Medicaid? Are you not privy to any of that Medicaid information given that you are administering Medicaid information? I gave you my Medicaid number on the application materials

Sending you Medicaid information on clients is not as easy as it was, as I assume you know. NC Medicaid stopped sending out any paper information over a year ago. Thus, I will have to go online, pull up the information, print out the information, and fax you the information.

I will send you the requested Medicaid client info.

I find it difficult to believe that you cannot turn up that NC Medicaid has paid me in the past 6 months, frankly.  You have all the information in front of you, including my Medicaid provider number.  You should be able to pull up hundreds of mental health outpatient therapy sessions' coding and payment processes.

Marsha V. Hammond, PhD

Here is Ms. Barlows e mail message to me regarding that she see that I have been billing Medicaid

On Mon, Jul 2, 2012 at 11:49 AM, Karen Barlow wrote:
> Dear Provider:>

Smoky Mountain Center (SMC) received your Provider Enrollment application on
 July 2, 2012, as postmarked June 29th. SMC does not show that your
 organization has a contract with us or has billed Medicaid on any SMC
 consumers within the last 6 months; therefore we will be glad to accept your
 application but it will not be processed until after July 1 and at that time
 SMC will make a determination of acceptance within our network based on
 capacity and need.>

You may provide evidence of eligibility to SMC by sending a copy of a
 Remittance Advice (RA) for dates between 01/01/12 and 06/30/12 that contains
 behavioral health billing codes linked to Medicaid numbers originating from
 one of the SMC 15 counties. The enrollee’s county must be in the SMC 15
 county catchment area, which include the following: Alexander, Allegheny,
 Avery, Ashe, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon,
 McDowell, Swain, Watauga, and Wilkes. Please redact any other identifying
 information before sending. Be certain that you identify the Medicaid
 number, the county of origin and highlight the corresponding Medicaid number
 on the RA.>

 You may submit evidence via scan email to or fax it to my attention at

 If you have any further questions or concerns, please submit via email at

Thank you for your interest in Smoky Mountain Center.
 Karen D. Barlow
 Credentialing Specialist/Support
 Smoky Mountain Center/Central Region
 825 Wilkesboro Blvd, NE
 Lenoir, NC 28645
 828-759-2160 x 3330


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