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Alerts
SUPPORTS INTENSITY SCALE (SIS)™
The Supports Intensity Scale is an assessment tool for measuring practical support requirements of a person with an intellectual disability. Unlike the traditional assessements, the SIS focuses on the daily supports that an individual needs to help him or her live as independently as possible within the community. The scale was developed by a team from the American Association on Intellectual and Developmental Disabilities (AAIDD).
North Carolina is implementing use of the SIS with several Local Management Entities (LMEs) including the Guilford Center.
The links below will provide you with additional information about the Supports Intensity Scale:
Questions and Answers About SIS (27K DOC)
SIS Examiner Listing (59K DOC)
SIS Practitioner Conference Call Minutes DMH/DD/SAS 11.06.09
Additional information about the SIS can be obtained by going to the Web site: www.siswebsite.org
VERIFY MEDICAID ELIGIBILITY EVERY MONTH
The following information is from the Basic Medicaid Billing Guide. Appendix A and Appendix F referenced in the text are also in the Basic Medicaid Billing Guide.
09.09 Basic Medicaid Billing Guide (4Mb PDF)
Medicaid Identification Cards
Individuals approved for Medicaid receive an annual Medicaid identification (MID) card. The exceptions are the MQB-B and MQB-E programs, from which recipients do not receive cards. The MID card does not serve as proof of recipient eligibility. The MID card indicates the recipient’s MID number, recipient’s name, recipient’s address, MID card issue date, and Medicaid managed care information (if applicable).
The annual cards are printed on gray card stock. DMA no longer prints blue, pink, green, and buff colored MID cards. The cards will include the individual’s name, MID number, and CCNC/CA primary care provider information (if applicable).
An exception to the one-card-per-year rule will be made for those managed care recipients who change their primary care physician and for those recipients who legally change their name. Recipients will also be able to ask the county department of social services to submit requests for replacement cards, if needed.
Providers may verify a recipient’s eligibility using the following methods:
Electronic Data Interchange—Interactive eligibility verification programs are available from approved electronic data interchange (EDI) vendors. These vendors interface directly with the Medicaid recipient database maintained by EDS. Refer to Interactive Recipient Eligibility Verification in Section 10, Electronic Commerce Services, for additional information.
Recipient Eligibility Verification Tool—Additional functionality has been added to the North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool interface that allows users to submit recipient eligibility inquiries to N.C. Medicaid. This function is accessed by the user selecting Recipient Eligibility from the menu items on the left side of the browser screen. Refer to Appendix F and to the September 2009 Special Bulletin, North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool Instruction Guide, for additional information.
Automated Voice Response System—Medicaid eligibility can be verified using the Automated Voice Response (AVR) system. Eligibility verification is available for services provided in the current month as well as for services provided within the past 12 months. Refer to Appendix A for information on using the AVR system and to Appendix F for step by step instructions on the Recipient Eligibility and Coordination of Benefits transaction 6 within the AVR system.
DMA Claims Analysis—To verify eligibility for dates of service over 12 months old, contact DMA Claims Analysis at 919-855-4045.
Refer to Appendix F, Verifying Recipient Eligibility, for additional information on verification methods.
Recipient Eligibility Verification Web Tool
The Division of Medical Assistance has created an application on the North Carolina Electronic Claims Submission (NCECS) web site to verify a consumer’s Medicaid eligibility each month. Providers may sign up free for a login ID and password. Instructions are in the September 2009
September 2009 Medicaid Special Bulletin.
Electronic Data Service (EDS) will also host conference calls for all providers on September 18 and 25, 10:00 to 11:00 AM. Contact providerhelpdesk@guilfordcenter.com for the call-in number and participant code.
Who Files a Mental Health Cost Report?
Link to the 2009 Cost Report
Any provider who is direct enrolled with Medicaid and provides/bills CAP - MR/DD, mental/behavioral health and residential treatment services has to file a Mental Health Cost Report.
There is no threshold amount that will qualify any provider for an exemption from the cost report. If a dollar is billed, a Cost Report is required.
There is no exemption based on the number of months a provider has been in business.
Cost Reports are due to the Controller's Office five (5) months after the provider's fiscal year ends.
Extensions to a Cost Report's due date are granted on a case-by-case basis. An extension must be requested in writing with e-mail being an acceptable form. This request needs to include the following information:
- Provider's name and mailing address
- A contact person's name, phone number, and email address
- Medicaid provider number(s)
- Federal tax ID number
- Reason for needing an extension
- Length of time needed for the extension
Approval or denial of the extension request will be sent to the provider. If the request was approved, a new due date will be included.
Contact these individuals with questions or concerns:
Susan Kesler
919.855.3680
Susan.Kesler@ncmail.netStephanie Robinson
919.855.3686
Stephanie.Robinson@ncmail.net
Possible Elimination of Level III and IV Residential Services
06.22.09 Memo Regarding Possible Elimination of Residential III and IV Services
Implementation Details for Transition to 60-Day Billing
07.16.08 Provider Help Desk Memo Regarding Transition to 60-Day Billing
CAP-MR/DD & Residential Treatment Providers Cost Reporting Training Sessions
Guilford Benefit Plan
New Community Support Definitions Released
New! Provider Fraud and Abuse Information
The Guilford Center Center's Secure Email Program
Clarification of Cost Reporting Requirements for Private Providers
06.01.07 NC DHHS Controller Memorandum on Clarification of Cost Reporting for Private Providers
Helpful Information for Providers of Community Support Services
Questions and Answers from the Guilford Center's January 30, 2007 Provider Forum
ValueOptions Updates Fax Number Information
New! ValueOptions Fax Number InformationFaxing Information to ValueEffective 2
Guilford Center Hosts Upcoming Provider Forum Meeting
ValueOptions Relocating to New Offices with New Local Telephone Numbers and Fax Number
Link to Updated ValueOptions Fax and Local Telephone Numbers
Information for Directly Enrolled Medicaid Providers Only Regarding Mental Health Cost Reporting:
Link to 1.17.07 Memo from DMA Senior Deputy Director and DHHS Controller
Important Announcement Regarding Sliding Scale Fees more...
Link to The Guilford Center's 2007 Sliding Scale Fee Schedule
Important Announcement Regarding Elimination of TNC Target Population Groups more...
Important Announcement Regarding Due Date Extension for Cost Reporting more...
The Housing 400 Initiative has posted applications and criteria in both the Supportive Housing Development Program (SHDP 400) and the Preservation Loan Program (PLP 400). The deadline for the SHDP 400 is February 28, 2007. The deadline for the PLP 400 is December 8, 2006. more...
Important Announcement Regarding Identity Theft more...
Cost Reporting for Medicaid Services Extends to Providers more...
Archived Alerts
Important Information! September 2006 Medicaid Bulletin in Publications and Reports from the Division of Medical Assistance (DMA) Web site more...
Reminder! The Deadline to Submit IPRS Claims for FY05-06 is Approaching more...
Register Now for State Video Conference on Community Support, Diagnostic Assessment& Services within Developmental Disabilities more...
Child Residential Providers: New Revised Endorsement Checklist more...
CAP-MR/DD Service Providers: Important News on changes in the authorization process more...
New Billing Procedure for Enhanced Services for Non-Medicaid Clients Being Funded Through IPRS more...
19th Statewide Community Support/Targeted Case Management Conference to be Held in Winston-Salem more...
Important Information from the State Regarding Uniform Screening and Registration of Consumers more...
New Phases for Provider Endorsement and Policy Amendment for Conditional Endorsement more...
New! IPRS Target Population Details and Form more...
Revised Forms Now Available more...
State Releases New PCP (Person-Centered Plan) more...
NC Division of MH/DD/SAS Announces Important Changes in Incident and Death Reporting System more...
State Announces Transition Timelines Regarding Medicaid Utilization Review more...
State Requires Letters of Notification for Termination of Medicaid Service more...
Center for Medicare and Medicaid Services (CMS) Approves Enhanced Benefit Service Definitions more...