Friday, November 23, 2012

Medicaid Waiver: Even Though Smoky Mountain Center LME States they Do Not Need Medicare information to Bill Medicaid, Billing Entities State the Opposite

When, if ever, will these travails every end? Will providers ever have the seamless billing BACK that they had when Medicare wrapped around to Medicaid automatically----PRIOR to this ridiculous Medicaid Waiver?  Though Smoky Mountain Center LME personnel indicate that they do not 'need' the EOB's or billing information from Medicare as 'they trust us' (the providers)-----the billing entities cannot bill SMC LME for the wrap-around Medicaid services without having the EOB's.

This is what my biller has advised me:

"....I can only produce 2nd claims electronically by putting in the primary/Medicare information on what they paid, so technically SMC does not need the physical paper EOB but do need the information to appear on the electronic submission.   My system will not produce a 2nd claim to any carrier without the primary information keyed in...."

Friday, November 09, 2012

Medicaid Waiver: More Difficulties w/ Re-credentialing at WHN LME versus Easy of Credentialing at SMC LME

Hello IT at WHN LME and Donna Baker Oliver (recredentialing of individual providers at WHN LME) :

I have talked to on the phone just now, the gentleman at IT at WHN LME.  I cannot open this link:

•Provider Evaluation Form (3/26/12) which is on this page:

You asked for a 'recomendation' from a LPA or PhD.  I know no psychologists in NC; they all ran away re: the travesty associated with NC medicaid, and in particular this Medicaid Waiver.

THEREFORE, I am utilizing two psychologists, PhD's, in GA, where I was previously licensed.

PLEASE let me know if this is a problem, Ms. Donna Baker Oliver.  Thank you for your returned call.  I am forwarding the forms to Mistie Sellars as you requested if your IT person can figure out where the form is.

In case you didn't know, the recredentialing process for SMC LME did not demand this and they quite willingly accepted the people that I regularly work with who are mental health professionals in Haywood county.

Thus, once again, WHN LME, has made this recredentialing process extremely difficult not to mention that your web link is not working.

I have had to go back and forth to the post office in order to pick up the certified letter that was originally dated October 3, 2012, simply telling me that I needed to have a Licensed Psych Associate (a master's degree person; the people that SMC LME accepted were master's degree people and a psychiatric nurse practitioner) or a PhD, such as myself.

Neither did SMC LME require me, as WHN LME did initially, to send in a copy of my 'college transcript' which is a moot point as the NC Psychology Licensing Board would not have licensed me if they had not seen that.  I, as well as any psychologist, am easily found at the NC Psychology Licensing Board.

Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist