Saturday, July 07, 2012

Medicaid Waiver Under WHN LME: without In Network approval, paperwork must be filled out one 9 page submission at a time

This is great. For each of my Medicaid clients, I have to fill in 9 pages of paperwork, include a W-9, face page of my malpractice policy, and try to get answers to questions like this, on page 8:

On page 8 of the Client specific Agreement application there is a

check box entitled: " direct enrollment w/ DMA for each service


What does this mean?? Does it mean that as I am a licensed

psychologist that I can provide outpatient mentalhealth services?

I just don't get what it is asking for. please advise ."

Then I have to print off the 9 pages, sign it with an original signature, send it via US mail to WHN LME, and then wait to hear from them. 

This is nothing but a ploy to use up all the Medicaid money doing paperwork rather than direct patient contact.  This is nothing more than a sleight of hand such that the LME's use most of the Medicaid money in administering this ridiculous amount of paperwork. 

Makes them look like they are doing something when in fact, they are simply devouring the Medicaid $$, leaving little for the care of Medicaid patients

Things were MUCH BETTER and efficient when it was centralized and Value Options was receiving the authorization requests and webclaims was being used for billing.

These 9 pages of paperwork has to be done patient by patient.  How did it USED to be? As a Medicaid Provider, I sent in a one page authorization request after the 8 unmanaged sessions were used, and Value Options sent me back verification of what I had requested.  Then I billed for those sessions, on line, quickly, as part of webclaims for NC DHHS------and not as associated with going thru some convoluted training process individuated LME-by-LME. 

HOW, I ask you, is this going save money? Or is the agenda to drive as many providers out of the Medicaid network as possible and have the LME's use the lion's share of the money?

This is just plain TRAGIC.


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