Thursday, October 18, 2012

I'm Praying that Smoky Mountain Center LME Takes Over Western Highlands Network LME-MCO

Western Highlands Network LME-MCO, is sandwiched in & between the north and south of Smoky Mountain Center LME.  SMC LME is, I believe, the largest LME in NC.  I'm impressed by the helpful attention that the personnel at SMC render to me, just a solo provider, in terms of authorizations and explanations re: their mostly non-functional alpha computer system (so far; they seem motivated; maybe they will fix it so I can put my authorizations into their alpha system rather than submitting them by fax like I used to for Value Options).   Today, for instance, a person in the authorization part of SMC called me to let me know that I did not need to render a 'Service Order' as associated with my authorizations for I am a licensed psychologist.  That was very helpful. 

This is tax payers money.  This is how they should be working w/ providers.  We are the people who provide the services that they are administering.

Contrarily, WHN LME-MCO, appears to be completely unhelpful at every level. 

I sent a certified return letter to the CEO (interim CEO subsequent to Arthur Carder being fired a couple of months ago due to the LME needing to ask for an infusion of $3 million) from the state). 

Here is that letter.  When I get to the point that I am ready to press a 'restraint of trade' suit, well, the fact that this was certified return, may come in handy.  I hope it doesn't come to that.  I simply do not know how to get WHN LME moving.  I have Medicaid clients under their jurisdiction----one who is in prison right now-----but I cannot get even an Out of Network agreement with them established.  They're asking for yet more paperwork, apparently, but I have no letter and no information about that.  I called them last week and that's what they told me.  They need yet more paperwork from this licensed psychologist who has provided Medicaid recipients with services for over 10 years .

PLEASE: SMC LME: make a sustained effort to take-over WHN LME.  I am advised by people at Copestone Partial Hospitalization---people who work there----that they have also 'heard bad things about Western Highlands.' 

"Dear WHN CEO, Charles Schoenheit:

I applied to be an In network Provider on 1.25.2012.  I was denied.  No clear reason was given other than I had not met the deadline. I attempted to again in March/ april, 2012. I was denied.  I applied as an Out of Network Provider in August, 2012.  I was denied, with the explanation being that yet more paperwork was required. I called Donald Reuss (heads up Provider Relations) onn Wednesday, 10.17.2012, idicating I had not received any paperwork re: "more paperwork required."  I have not heard from him, as I requestsed.  Please forward to me any requested further paperwork.  There are NO judgements/ issues re: my psychologist license.

Sincerely, Marsha V. Hammond, PhD"


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