Wednesday, October 24, 2012

No Response from Western Highlands Network LME CEO re: my Out of Network Medicaid Application: the Perils of the Medicaid Waiver

From: Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 5197

To: Donna Baker Oliver, Provider Relations,working w/ solo practitioners at Western Highlands Network LME-MCO   e mail:

RE: Out of Network re-credentialing application for long-time Medicaid provider

Date: October 22, 2012

Dear Ms. Oliver:

Today, Kelly, in Provider Relations, advised me that you are the contact person for the re-credentialing process for Medicaid providers as associated w/ solo practitioners .

I was advised that on Sept 20, 2012, my Out of Network (OON) application would be reviewed. I first submitted an application to WHN LME on Jan 25, 2012.

 I heard nothing after the September 20, 2012 meeting and so 10 days ago called WHN and asked what is going on.  That person advised me to 'call back' if I did not have a letter.  I do not have a letter from WHN LME.

I then sent a certified return letter to the CEO of WHN LME advising him that I had attempted to become an In Network provider, was refused for no reason other than my application was received after the January 3, 2012 deadline (January 25, 2012, to be specific).  I also outlined my continued attempts to be an OON Provider.  I have heard nothing from him.

What other materials do you need from me in order to establish myself as an Out of Network provider? I have Medicaid clients in your catchment area that I have continued to see even though I am not being paid to see them.

Prior to the Medicaid Waiver, Medicaid in NC worked very efficiently.  Authorizations were submitted to Value Options and my billing was done, by myself, very quickly and dependably, online at an HP interface.

After the Medicaid Waiver, I was required to sit through 8 hours of non-paid training at Smoky Mountain Center LME in order to utilize their alpha computer software, which is not up to speed, and therefore I had to submit my authorizations to continue to see my Medicaid clients by fax/ paper.  Fortunately, they were OK w/ this.

I now have to pay double for my biller to do my Medicare/ Medicaid billing (many clients are 'dually eligible' and  have both Medicare and Medicaid).  Prior to the Medicaid Waiver, Medicare automatically wrapped around to Medicaid.  Now I pay my biller twice as much for the same billing.  .

Contrary to Western Highlands Network, Smoky Mountain Center LME very efficiently moved through my In Network Provider application.  It has been very easy to work with them.  It has been extremely difficult and time consuming trying to work w/ WHN LME.

This is not helpful to Medicaid consumers nor to Medicaid providers.

Pass this information to anyone you like.


Marsha V. Hammond, PhD, Licensed Psychologist

cc: co-chairs of Joint Legislative Oversight Committee for Mental Health/ DD/ SA:, "Rep. Justin P. Burr" ,


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