On Thursday, September 1st, ValueOptions requested to attend the Professional Association Council (PAC). NASW-NC is apart of this Coalition, meeting monthly to represent licensed professionals across North Carolina. The request for ValueOptions to attend our meeting was to inform us about a spike in denials of authorization and ways they are working to address the issue.
There are several points they wanted our members to be aware of when submitting authorizations:
1) Most of the time, reductions for requests are due simply by not having clinical information provided on the request(this information is missing from the request). Information such as diagnosis and treatment changes need to be noted, clinical support for service definitions need clinical support, no provider number listed, etc.
2) Lack of knowledge about due process rules that changed in May of 2011. For more information on this, click here or here for due process and prior approval information.
3) New process for submitting requests: Electronic submission mentioned in the August 2011 Medicaid Bulletin- this is effective 0ct. 1st, 2011. Providers will need to sign up with the Provider Connect website to submit requests, see authorization letters, etc. Click here and see the Section 1 for more information on Provider Connect.
ValueOptions is committed to help the providers of NC work with Best Practice standards. For more information on Practice Guidelines, click here.
NASW-NC Members: If you have any questions about this information, please contact Kay Paksoy at the chapter office.