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"
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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