Effective December 12, 2016 the Alliance Provider Network Credentialing Department are no longer require provider references for LP, LIP, Agency and Group applications. Associate Clinicians applying are required to submit their supervision contract and attestation.

Information for Providers on Enrollment and Credentialing

Interested in becoming a Network Provider with Alliance Behavioral Healthcare? Our Enrollment and Credentialing page provides everything you need to know.

Network Status

Application Information

  • 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.

Credentialing FAQs

What is the process for adding a clinician to my agency?

  1. Agency sends the completed Add Licensed Practitioner Request Form to ProviderNetwork@AllianceBHC.org.
  2. 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:

  1. 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.
  2. Once Provider Network Operations receives the fully-completed requested information, the provider will receive an email stating all information has been received.
  3. Provider Network Operations will then forward to a Credentialing Specialist, who completes the following tasks:
    1. Confirm credentialing status of the LP.
    2. Confirm agency is a contracted provider.
    3. Confirm that agency and practice address listed on the application is approved for Outpatient Services.
  4. 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.
  5. The Credentialing Specialist will then link them to the agency in Alpha based on the date Alliance received the completed enrollment packet.
  6. 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:

  1. Provider Network Operations will review CAQH database to determine if the LP is already connected to CAQH. If the LP is registered with CAQH:
    1. Provider Network Operations will add them to the Alliance CAQH roster
    2. CAQH application must be current (dated within 14 calendar days) and complete.
  2. 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.
  3. 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.
  4. Once Alliance receives the email with the enrollment packet from the provider:
    1. 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.
    2. 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.
  5. If the enrollment packet is not accepted by Alliance and returned to the provider:
    1. The provider must provide the information that has been identified as missing or incomplete (including any updates to CAQH).
    2. The provider should not return the packet until all elements are updated (including CAQH).
    3. If the packet is submitted with missing information it will be deemed incomplete and returned to the provider.
    4. Please note that the entire packet will need to be resubmitted each time.
  6. 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.
  7. The LP packet will be forwarded to the Credentialing Specialist who is assigned to the agency to complete the full credentialing process.
  8. The Credentialing Specialist will process the application for full credentialing
    1. 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.
    2. This email will be sent to both the LP and the agency.
    3. 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.
      1. If the Agency wishes to submit an application in the future for the LP, the process will start over.
      2. Effective dates will be dated to the date the completed enrollment packet was received and accepted by Alliance.
  9. 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.
  10. Once the Provider Network Operations Credentialing Committee makes a decision the agency and the LP will receive written notification of the Committee’s decision.
  11. 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.

Agency Recredentialing

Alliance is beginning the re-credentialing process for all of our agency network providers. Network providers will be contacted individually and will be invited to attend an informational workshop when their time to be re-credentialed is identified. During this workshop the re-credentialing process will be reviewed along with the application and documentation requirements.

Network providers will have thirty (30) days from the date they receive their re-credentialing application packet to submit their completed application packet. Ongoing technical assistance workshops will be provided to assist with any ongoing questions during the process.

Important Considerations:

  • It is important that once a network provider has been notified to be re-credentialed that all identified timeframes and expectations for the re-credentialing process are met in order to stay enrolled in the Alliance Network.
  • Re-credentialing is ONLY occurring for sites and services that you are already enrolled in the Alliance Network to provide. This is not an opportunity to add sites and services.
  • All submissions need to be electronic (E-mail). We cannot accept fax, delivery (mail, FedEx, etc.) or hand delivered applications.
  • Re-credentialing packets need to be submitted in their entirety. Incomplete applications will not be accepted and will be returned to the provider.

Below is a list of items that will be asked for during the re-credentialing process for Agencies and Groups (additional information will be posted for LIP (Solo) when that re-credentialing process begins):

  • NPI number should match at least one site location under the agency (typically the main site location). If a provider wishes to use unique NPI numbers for each practicing site location they may do so by indicating the specific/unique NPI number on the site enrollment form.
  • NCTracks – ensure each NPI number (agency, site and LP) is registered in NCTracks and that benefit plans have been chosen.
  • Organizational chart need to list positions as well as names associated with the positions.
  • Identify owners, managing employees, Board of Directors, CABHA Director Positions and authorized EFT employee. Be prepared to provide their name, address, SSN, date of birth and title. Board of Directors do not need to supply SSN number.
  • Accreditation  information – name of accrediting body and current dates of accreditation.
  • Accurately answer questions about any current, past and/or pending sanctions, adverse actions and criminal backgrounds for your ownership, managing staff, Board of Directors and clinical staff. Failure to disclose is grounds for denial.
  • Contact information for your billing agent.
  • List of all LME/MCOs that you have a contract with.
  • Copies of all Facility and/or Service Licenses for sites credentialed by Alliance.
  • Ensure Secretary of State filings are up to date (corporate address).
  • Submit a copy of the Certificate of Insurance for Professional Liability from the organization’s insurance carrier that meets the minimum amounts of $1,000,000/$3,000,000. For organizations that provide outpatient and/or psychiatric services, each individual clinician must be listed, by name, on the organization’s Certificate of Insurance for Professional Liability.
  • Submit Certificate of Insurance for Automobile Liability insurance for company vehicles, and employee (include contracted employees) vehicles that are used to transport consumers. ($500,000 per person and per occurrence or has a combined single limit of $1,000,000).
  • Submit Certificate of Insurance for Workers’ Compensation from the organization’s insurance carrier that meet the minimum amounts of not less than Bodily Injury by Accident $100,000 each Accident/Bodily Injury by Disease $100,000 each Employee/Bodily Injury by Disease $500,000 Policy Limit.
  • Submit Certificate of Insurance for General Liability from the organization’s insurance carrier that meets the minimum amounts of $1,000,000/$3,000,000.
  • Alliance Behavioral Healthcare name and address should be listed as the Certificate Holder.
  • Submit a current LP roster (if applicable).
  • Submit an annualized budget. Most recent certified audit or the most recent Board approved financial statement.
  • For Profit entities to submit a CFO statement of financial capacity.
  • Prepare site specific information that includes contact information, service information and emergency coverage information. Referral contact information should be provided for each site location.
  • Submit a listing of CABHA personnel and their individual contact information (if applicable).
  • Policies and procedures that reflect the implementation of all state standards. Must contain a table of contents that includes page numbers references.
  • If no changes to previously submitted policies and procedures, a signed and dated attestation that indicates no change in the Policy and Procedures that was submitted with your original application.

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.

Ask a question regarding authorizations.

Ask a question regarding site and service setup in Alpha.

Providers are required to continue following the current Out of Network Process for licensed AFLs and/or licensed group homes.

Innovations Residential Supports-Licensure and Application

The following are the options for license holders. Please note this is a change from previous communications.

DHSR License holders can continue as a subcontracted provider with an Alliance Residential Supports Network Provider.

If a DHSR License holder had submitted a Credentialing application to Alliance by the deadline of December 27, 2013 you will be contacted by Alliance to determine if you would like to continue with the credentialing/application process to be reviewed for an independent contract with Alliance. During the credentialing process the license holder should remain as a subcontracted provider with the Alliance Residential Supports Network Provider they are currently contracted with until a Credentialing decision (approval or denial of application) is made.

If the license holder’s Alliance credentialing application is denied the license holder may still continue to subcontract with a Residential Supports Network Provider if they wish to do so.

If a license holder is in the process of transferring its DSHR license to the Residential Support Network Provider the license holder may continue to do so if they wish. However, they also have the option of keeping the DHSR license instead of transferring the license to the contracted Residential Supports Network Provider.

Licenses Required to Provide Residential Supports

Clinical Coverage Policy No: 8P also requires that Residential Supports licenses be a 27G.5600B, 27G.5600C or 27G.5600F license. After January 1, 2014 Alliance will require newly-licensed supervised living facilities with three (3) beds or less, or existing facilities with six (6) beds or less, to be licensed as either a 5600B or 5600C. No other license is acceptable under the service definition.

Supervised living facilities, type F, which service no more than three (3) minors or three (3) adults with a developmental disability must be licensed as a 5600F. Supervised living homes with only one (1) adult may continue to operate without a license as long as they meet the requirements of the service definition.

Due to the requirements contained in Clinical Coverage Policy No. 8P Alliance will no longer accept a 27G.5600A or a Family Care License as an acceptable license for Residential Supports.



Page last modified: March 3, 2017