Wednesday, September 26, 2012

Smoky Mountain Center Refuses to Make Good on the Value Options Out-Patient MH Authorizations Put into Place Earlier this year.

This is great.  Now I have to do all my authorizations again....hours and hours of unpaid work.  Why, you ask.  Because, apparently, SMC LME-MCO, who started their Medicaid waiver July 1, 2012, has refused to to utilize Value Option's (the company who has been doing Medicaid waivers for years) authorizations.  They will use SOME OF THEM----the ones that got pulled over apparently----but not all of them.

This leaves me losing HUNDREDS OF $$.

Time for a call to the NC State Legislature Joint Legislative Oversight Committee for Mental Health.

Here is my correspondence between Toni Shelow, Care Management Director), at SMC LME-MCO:

From: Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 1127
Medicaid Provider Number: 6000320
NPI: 1194700591
e mail:

TO: Toni Shelow, x 1223, Care management director, SMC LME

RE: you don't seem to have the authorizations for my clients from VO

Hi Ms. Shelow:

I left you a message; Ms. Gossman a message; Mr. Ingram a message; Ms.
Stiles I talked to x2.

You do not seem to have been able to gather up the authorizations I
put into place in February, 2012, from VO, though they indicate per
telephone call today, that you should have that info.  What I very
much do not want to do is to go thru each dually eligible or medicaid
only client and obtain the authorization number and parlay that to you
so that I can be paid for what I was authorized for months ago.
Moreover, I have no idea where to put the authorization number as per
the CMS 1500 form.

Specific to my phone call today, I am asking about simply one client
(there are many others; let's start here):

initials: --------------------------------------------------- VO
today, on the phone, authorization beginning 3.16.2012 thru
12.31.2012---- for 43 sessions is: 01-031612-51-37.

Can you obtain that info so that I can bill?  Where do I put that on
the CMS 1500 form?

 Or do I need to give you the authorization numbers from VO----which
they indicate has been passed to you?  As you know, I must bill within
3 months of rendering services and that would be the end of September.

Please advise.

Thank you.

Marsha V. Hammond, PhD

(There is no confidential information in that e mail and so I am posting it)
Toni Shelow
8:51 AM (2 hours ago)
to Stephenmefanny.gossmanBrianSharon
Ms. Hammond,

I received your voice message and I apologize for any difficulties you are encountering. For your clients who are receiving basic benefit services, those restarted on July 1, giving you 8 unmanaged sessions for adults and 16 for children.  While VO had authorizations that went through the end of the year, as an MCO we did not transition basic benefits to the end of VO's authorization.  In order to bill for your clients past the basic benefit number of sessions you would need to submit a Service Authorization Request (SAR) for the sessions that you deem medically necessary for each client.  Keep in mind also that in January, the basic benefits will be re-set again and you will be able to have 8 and 16 unmanaged sessions again prior to requiring authorization.  If you have any addition questions or need further assistance please let me know.

Toni Shelow, Psy.D.
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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.
Marsha Hammond,PhD
11:32 AM (3 minutes ago)
to toni.shelowbriansharon.stiles
You are kidding me.

You're saying that you will not make good on the VO authorizations.

I was told by Sharon Stiles (I think: I may be wrong here and I am not
trying to blame her) that if I could pull forward indication that
there were additional authorizations originally created by VO, that
they would 'surely' be good.

Is this written in your rules and regs or do you just determine that
this is the way it will be?

Are there not any other providers to have something to say about this,
the fact that you have completely dismissed the authorizations that
were put into place by VO?

I will call Mr. Ingram in a bit and cc him now.  And then I think I
will call the co-chairs of the Joint Legislative Oversight Committee
for mental health.  They need to know that this is taking place and
further wrecking public mental health in NC....if they even care.

this is really too much.  We do all this work re: authorizations, do
what we are supposed to do, and then you pull the rug out from under
us in the middle of the year.

Thanks.  I await your further information.

Marsha V. Hammond, PhD


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