Information for Providers on Enrollment and Credentialing
- At this time we are not accepting applications for network membership at large. However, from time to time, targeted service needs may be identified and these will be posted on this website and in the Alliance provider news feed. View any service needs currently in effect.
- 1 Information for Providers on Enrollment and Credentialing
- 2 Credentialing FAQs
- 3 Credentialing Staff Assignments
- 4 Agency Recredentialing
- 5 Unlicensed AFL Site Additions
- 6 Innovations Residential Supports-Licensure and Application
- All fully-licensed and Associate-licensed outpatient therapists need to be credentialed by Alliance. Please ensure enrollment applications are submitted for all of these clinicians.
- Alliance’s Credentialing Department requires that all applications and subsequent required documentation be submitted via email attachment only. Anything received via fax, mail, delivery service or by dropping off at office will not be accepted. All credentialing information can be emailed to ProviderNetwork@AllianceBHC.org.
- Currently contracted agencies and group practices that wish to add additional clinicians will be required to complete a Request to Add Licensed Clinician.
- This form will be reviewed and a checklist of needed documents, along with the application, will be emailed to the requesting provider. The application and required documents will need to be submitted in its entirety or the application will not be accepted and will be returned to the provider. Applications that are received outside of this process will be returned to the provider.
Professional Liability Insurance Requirements
- Agencies and groups that provide outpatient therapy and/or psychiatric services must list each practitioner on the agency/group professional liability insurance certificate who are credentialed with Alliance. Alliance requires a copy of the agency/group professional liability insurance certificate and/or attachments on the insurance company’s letterhead that list the practitioner and coverage limits or the attestation letter and copy of the agency/group insurance certificate when an enrollment application is submitted for each practitioner. Access a sample attestation letter.
- Agencies may also submit a certificate for their agency that lists all of their practitioners to help reduce numerous requests to insurance companies. When adding new practitioners, agencies would be required to submit the updated professional liability certificate with the new practitioner added. This includes any practitioners (both contractors and employees) that are billing under the agency.
Notifying Alliance of Changes in Business Operations
- All providers are required to notify Alliance at ProviderNetwork@AllianceBHC.org in advance regarding potential site address changes, mergers/acquisitions, name or tax ID changes, or any other potentially significant changes that may be under consideration. Alliance staff will work with providers to identify any issues that may arise due to potential changes and how to best navigate within the MCO model around these changes.
Site Visit Requirement
- Effective for all applications received after February 1, 2015: All Providers being considered for a Network Contract will be required to have and pass an on-site visit by Alliance Provider Network staff prior to enrollment into the Network. This applies only to Providers applying for services/sites that are NOT licensed by DHSR. Providers will be contacted by a Provider Network staff to set up a site visit after your Credentialing application has been accepted and all required documents and verifications have been completed. Alliance strongly encourages Providers to review the initial on-site visit tool to prepare for the visit.
- Effective October 1: Alliance will begin utilizing the DHHS New Unlicensed Site Review Tool for any current provider that has approved address changes or approved address additions for unlicensed sites to their current contract. This site visit needs to be conducted no later than within 30 days of the change. The need for the site visit will be identified once the provider has submitted the Notice of Change form indicating the address change or addition. Advance notification and subsequent approval of any address change or addition are required. Providers are encouraged to review the tool prior to the site visit.
What is the process for adding a clinician to my agency?
- Agency sends the completed Add Licensed Practitioner Request Form to ProviderNetwork@AllianceBHC.org.
- Provider Network Operations staff will review the request to determine if the LP is already credentialed with Alliance.
IF LP IS ALREADY FULLY CREDENTIALED WITHIN THE ALLIANCE NETWORK:
- If the LP is already fully credentialed with another agency, Provider Network Operations will reply to the request asking for the agency’s Certificate of Liability Insurance with the clinician listed or an attestation letter.
- Once Provider Network Operations receives the fully-completed requested information, the provider will receive an email stating all information has been received.
- Provider Network Operations will then forward to a Credentialing Specialist, who completes the following tasks:
- Confirm credentialing status of the LP.
- Confirm agency is a contracted provider.
- Confirm that agency and practice address listed on the application is approved for Outpatient Services.
- All LPs are required to be fully registered with NC Tracks. If the LP is not fully-registered in NCTracks (affiliation with agency and DMH Benefit Plan chosen) they will be added to Alliance upload to send the LP information to NC Tracks.
- The Credentialing Specialist will then link them to the agency in Alpha based on the date Alliance received the completed enrollment packet.
- Once the LP is linked in Alpha, Alliance will send an email verifying that the LP is linked to the agency to provide Outpatient Services to Alliance enrollees. If the Agency also has a State contract and the LP is not in NCTracks (as indicated in #5 above) the email will also state the LP is not approved to provide Outpatient Services to State contract consumers.
IF LP IS NOT CURRENTLY CREDENTIALED WITHIN THE ALLIANCE NETWORK:
- Provider Network Operations will review CAQH database to determine if the LP is already connected to CAQH. If the LP is registered with CAQH:
- Provider Network Operations will add them to the Alliance CAQH roster
- CAQH application must be current (dated within 14 calendar days) and complete.
- If clinician is not registered with CAQH Provider Network Operations will email agency directions on how to complete the CAQH online registration and NC State standardized application.
- Provider Network Operations will email the provider a credentialing enrollment packet which will include a checklist indicating what needs to be completed. The credentialing packet must be emailed to Alliance to start the credentialing and enrollment process.
- Once Alliance receives the email with the enrollment packet from the provider:
- The application is reviewed for completion (including review of the CAQH as well as the items submitted). All signatures should be dated within 14 calendar days of submission.
- If items are missing and/or incomplete Provider Network Operations will not be able to accept the application. The enrollment packet will be rejected/returned to the provider with an explanation of what is missing/incomplete.
- If the enrollment packet is not accepted by Alliance and returned to the provider:
- The provider must provide the information that has been identified as missing or incomplete (including any updates to CAQH).
- The provider should not return the packet until all elements are updated (including CAQH).
- If the packet is submitted with missing information it will be deemed incomplete and returned to the provider.
- Please note that the entire packet will need to be resubmitted each time.
- Once Alliance receives a completed enrollment packet the provider will receive an email from Provider Network Operations stating that the application has been accepted. LPs will not be added to Alpha for billing until the credentialing application is approved by Provider Network Credentialing Committee. The effective date will be the date the enrollment packet was accept.
- The LP packet will be forwarded to the Credentialing Specialist who is assigned to the agency to complete the full credentialing process.
- The Credentialing Specialist will process the application for full credentialing
- If additional information is needed during the full credentialing process, the Credentialing Specialist will send an email that will outline what is needed and timeframes that information needs to be submitted.
- This email will be sent to both the LP and the agency.
- If information is not received within time frames identified in request the application will be deemed incomplete and will not be processed any further. The agency will receive written notification of this decision.
- If the Agency wishes to submit an application in the future for the LP, the process will start over.
- Effective dates will be dated to the date the completed enrollment packet was received and accepted by Alliance.
- Once any additional information is obtained and the Credentialing Specialist completes the primary source verification process the LP’s enrollment packet will be forwarded to the Provider Network Credentialing Committee for a decision regarding approval as an LP in the Alliance Network. The Credentialing Committee meets a minimum of twice a month.
- Once the Provider Network Operations Credentialing Committee makes a decision the agency and the LP will receive written notification of the Committee’s decision.
- If Alliance enrolls the clinician into NCTracks the CEP authorization number for NCTracks will be included on the credentialing approval letter.
How will we know when network is open to add new providers/services?
When Alliance has a need for new services/providers, the information will be listed on our website on the home page and/or main credentialing page.
Why is it important to provide Alliance with an up to date LP Roster?
With an updated LP Roster we are able to compare the clinicians that are currently employed with your agency to the ones that are linked to the agency in Alpha. To bill for services provided by a clinician to Alliance consumers they must be fully credentialed and linked to your agency in Alpha.
If I filled this form out six months ago why do I have to complete it again?
All documents that include a signature and date must be less than 180 days old by the time the Provider Network Credentialing Committee conducts final review.
May I go ahead and submit my application when I submit my request to add clinician form?
When submitting the request form do not include anything else with it. The forms that need to be completed will be emailed to you. We will not be able to accept any additional forms that you send with the request to add form.
Unlicensed AFL Site Additions
Effective March 1 Alliance will no longer set-up unlicensed An out-of-home setting where the participant receives 24-hour care and lives in a private home environment with a family (or individual) where the services are provided to address the care and rehabilitation needs of the participant. Any AFL providing services to a child/children or two or more adults requires a license (as defined by NC General Statues 122C-3 27G .5600F). Waiver funding may not be utilized as payment for room and board costs.“>AFL homes as individual sites in provider contracts. All levels of Innovations Residential Supports for unlicensed AFLs will be linked to the providers’s Main/Corporate site in Alpha. Alliance I/DD The Alliance department responsible for approving Individual Support Plans and authorizing medically-necessary services. Care Managers work in the UM Department.“>UM (The person who is approved to receive services under the NC Innovations Waiver. “>Participant’s individual site location.
Contracted providers are no longer required to submit Unlicensed AFL Site The agencies or professionals under contract with Alliance Behavioral Healthcare to provide authorized services to eligible individuals. “>Provider Network email address. However, if a Waiver Participant moves to a new Unlicensed AFL at any time, this must be reported to the member’s I/DD A qualified developmental disability professional at Alliance who assists by developing the person-centered Individual Support Plan (ISP), coordinating services, and monitoring to assure quality services are being delivered and that health and safety needs are addressed. “>Care Coordinator immediately so that the member’s plan information can be updated. Providers should ensure that claims submitted for payment are consistent with the authorized site to avoid delay in payment. An updated contract amendment will be emailed to the applicable Providers.
Providers are required to continue following the current Out of Network Process for licensed AFLs and/or licensed group homes.