Wake LME Computer System Implementation Impact on IPRS and

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Wake LME Computer System Implementation Impact on IPRS and Powered By Docstoc
					                                       Wake LME
                        Computer System Implementation Impact on
                      IPRS and Targeted Case Management Providers
                                               12/21/09 Notice
Wake LME is changing from the UniCare software system to NetSmart Avatar & CareLink effective Jan 1,
   A. Terms and Definitions
         o UniCare – the old computer system Wake is replacing.
         o NetSmart – the company behind Avatar and CareLink.
         o Avatar – practice management and managed service organization software, which includes
             client data, authorizations, and claims processing.
         o CareLink – web-based portal for providers affiliated with an LME using Avatar, which includes:
                  access client demographic data and authorization
                  request authorizations and monitor authorization status,
                  transfer electronic documents to and from the LME regarding clients/authorizations,
                  submit and bill treatment services against an authorization for payment.
         o Calcium – Web-based calendar, not associated with NetSmart, used by Comprehensive Clinical
             Assessment Providers to indicate available intake appointments, and used by Wake LME
             STR/Access Center to schedule appointments for new clients with their chosen provider, 24/7.
   B. Changes in how and what consumer information is submitted for new enrollments:
         o Screening, Triage, and Referral (STR) has recently become the responsibility of Wake LME’s
             new Access Center (and is no longer provided by CAS).
         o Providers seeing new consumers can either (1) contact the Access Center by phone (available
             24/7) for an STR with the consumer present or (2) complete an STR (using the state form) and
             submit to the Access Center. NOTE: STR is not a reimbursable service.
         o The Access Center staff will obtain from the consumer or Provider the information required on
             the State’s STR form.
         o The Access Center may issue a Initial Authorization to the Provider via CareLink for MHSA
         o If the Access Center is initiating the referral, the appointment will be entered in the Calcium
         o Jan 1, Providers are to discontinue using Wake Demographic and Consumer Enrollment forms,
             and begin using the State’s LME Consumer Admission Discharge form (LCAD) instead.
         o Around Feb 1, instead of being submitted over fax machines, the LCAD form and Fee App will
             be submitted as electronic attachments to Authorization Requests over CareLink.
   C. Changes in how authorizations are issued and requested:
         o All IPRS providers will be issued a User ID and password to access the CareLink system on the
         o Providers will receive training on the use of CareLink in late January 2010.
         o Providers will begin requesting authorizations via CareLink about Feb 1, 2010, instead of on the
             paper Service Authorization Request form.
         o Providers will be able to submit clinical information by attaching Word documents or scanned
             PDF files to the authorization request.
   D. Changes in how authorizations can be tracked by providers:
         o Providers will be able to see a list of authorizations in CareLink, with their status indicated (Not
             Yet Reviewed, Pending, Approved, Denied)
         o The Comments section of the authorization will allow the LME Care Managers to communicate
             additional information needed from the Provider.
   E. Changes in how claims are submitted and processed:
         o Starting in February 2010, Providers will begin entering claims through CareLink.
         o Claims submitted via CareLink will be entered after selecting the appropriate authorization –
             CareLink will not allow entry of a service that falls outside of the limits of the authorization.
         o Providers will receive payment the same as currently.
         o Providers will receive an EOB in a different format than currently.
         o Claims submission via 837 is under development and will be available in the spring.
Critical Dates for Providers:
      December and prior dates of service are to be submitted the old (current) way by Jan. 8, 2010.
      ALL claims submissions after that date will be entered through CareLink – You can no longer submit
       claims by spreadsheet after Jan. 8, 2010.
    Hold January claims until after you receive your CareLink training, in late January.
    During the month of January, the LME will be processing 2009 claims through UniCare and closing out
       that system.
    In January, the LME will re-enter existing authorizations in Avatar so that you will be able to access the
       authorizations with their remaining units in CareLink. These re-entered authorizations will have a new
       authorization number, but this is not an issue, as you will be submitting your claims by selecting the
       appropriate authorization in CareLink.
    During January ONLY, Providers may still request authorizations using the current Service
       Authorization Request form, by fax or drop off. You will receive a printed authorization confirmation
       from Avatar during January that is different from the current Authorization Mailer.
    Jan. 1 2010, Providers are to discontinue using Wake Demographic and Consumer Enrollment forms,
       and begin using the State’s LME Consumer Admission Discharge form (LCAD) instead.
    The supporting clinical documentation is still submitted in hardcopy with the Service Authorization
       Request during January.
Referrals and Initial Authorizations:
    Starting in January, the Access Center will fax a modified version the STR form with the current
       Referral Coversheet, and printed copy of the initial authorization.
    In the January training, Providers will be given a date on or around Feb 1, 2010, to start using
       CareLink. Beginning on that date:
           o You will be able to view authorizations issued by the LME Access Center and Care Coordination
               in CareLink – they will no longer be faxed to you.
           o You will request Continuing Authorizations via CareLink. The current Service Authorization
               Request form will no longer be used, and you will no longer receive a printed authorization
           o You will begin attaching electronic (scanned) copies of all other paperwork to your authorization
               request in CareLink.
           o You will be using the LCAD form instead of the Demographic and Consumer Enrollment forms.
           o You will submit Claims via CareLink.
DD Agencies:
   Starting with authorizations effective Feb 15, each DD agency is responsible for requesting their own
   authorizations, 14 days prior to the expiration of the current authorization. (For example, if the
   authorization for DT is to start on February 15, the DT agency would submit on February 1st.) This is no
   longer the responsibility of the Lead Agency. The Lead or TCM Agency is still responsible for ensuring the
   PCP and NC-SNAP are completed and submitted timely.

Information Required on Direct Enrolled Clinicians of Contract Providers
   1. Complete the web based survey to submit information when you hire new professional clinicians. Go to
      URL: http://www.surveymonkey.com/s.aspx?sm=HXZ_2bUgwQvvBVJmvm_2btuLYg_3d_3d
      to complete the survey (copy and paste this URL into your browser)
   2. Include licensed behavioral health outpatient clinicians who provide IPRS services. Do NOT include
      staff who provide enhanced services only. Provisionally licensed staff are optional, as the data would
      not used for billing, but would be used for looking up specialties in your agency.
   3. To maintain accurate information, the LME plans to send an email routinely to your designated
      manager with a list of all the information the LME currently has regarding your staff.
   4. Without NPI numbers and other information on this survey, the LME would be unable to process
      payments for services rendered by those professionals after January 1st.
   5. This survey will also provide information about professional staff specialties for Access Center staff
      when giving consumers choice of providers.

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