Wednesday, August 22, 2012

Western Highlands Network has taken Nine Months to Credential me in any way

I first started sending in my re-credentialing information...all 45 pages of it currently.....on 1.23.2012.  I have been in repeated correspondence w/ this LME for 9 months re: this application.

I have been a Medicaid provider for over 10 years yet I cannot see my Medicaid clients due to the inefficiency of WHN LME.  Yet, WHN LME has applied the Medicaid Waiver in such a way that they are $3 million in the hole and I believe the reason is that the private companies, to whom they refer (I have never received a referral from WHN LME or SMC LME though I am in-network w/ SMC LME) is that the private companies stack services.

What do I mean by this?  STACKING services is associated with providing multiple Enhanced Benefits associated w/ Medicaid.  A Medicaid client with a SPMI (Severe Persistent Mental Illness) or a Developmental Disability, will receive, on average, from these companies:

1. Psychosocial Rehabilitation : meets 5x/ week for about 5 hours, includes cognitive skills training in a group therapy setting
2. access to a psychiatric provider (they are scarcer than hen's teeth out here in western NC and none of them are going to take Medicaid clients or they just eat the costs as they are not going to fill out 45 pages of paperwork)
3. Community Support Team
4. a therapist.

Today is August 20, 2012.  I received this e mail today re: my Out of Network Credentialing application (they have told me I cannot be an In Network Provider as I did not file by the deadline of 1.3.2012):

"Dear Ms. Hammond,

I have received your Credentialing application. Your application is
scheduled to go to the Credentialing Committee on September 20, 2012.
This is the next scheduled meeting of the Credentialing Committee. If
the committee needs further information I will be in touch with you. If
you have any questions, please feel free to contact me.

Mistie Sellers
Credentialing Specialist
Provider Network Operations
828-225-2785 ext 2231"


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