Services
The vendor who determines 1915i service eligibility
What is Carelon/State of NC?
Alliance, Partners, Trillium, Vaya
What are the names of the remaining 4 MCO's?
Number of active members divided by successful contacts
What is Billing efficiency?
December 1, 2022
What day did Tailored Care Management in NC launch?
RHA employee portal
What is Workday?
The entity/process that determines approval of 1915i service AUTHORIZATION/Medical Necessity
What is the MCO/SAR process?
EastPointe and Sandhills
What MCOs were involved in consilidation?
Interaction with member or member legal guardian in one of the following six categories: Comprehensive Care management, care coordination, health promotion, comprehensive transitional care/follow-up; individual and family supports; referrals.
What is a qualifying or billable contact?
72 hours
What timeframe should Level II or Level III incidents be entered into IRIS system
The "source of truth" for TCM assignment/eligibility.
What is NC Tracks?
Innovations; Supported Employment (Behavioral health or IDD);Respite; In home skill building ; One time transitional costs ; Individual and Transitional Supports,; Community Living and Supports
What are HCBS/1915i services?
North Carolina integrated health, pharmacy, care coordination, and behavioral health services.
What is Tailored Plan
Must be completed within 30 days of CMCA
What is the Care Plan?
MAHEC Bundle 1, Standard of Care, 1915i Assessment, HCBS Monitoring.
Internal platform to determine if members have other RHA mental health services.
What is Pacenet?
ACT; ICF-IDD; SNF; CAP/C; CAP/D; Primary Care Management; High fidelity wraparound; Tribal option; PACE
What are Duplicative Services?
2 TYPES of Medicaid Plans in NC
4601, 4602, 4603, 4604, 4605, 4606
What are the TCM cost centers?
Due on employees anniversary
What is annual TB screening?
External referral platform for member resources
What is NC Care 360/Unite Us
Inability to have 2 services provided by same provider
What is HCBS conflict/Federal Conflict free rule?
Provider Central, Provider Connect, Provider Direct
What is MCO portal?
Passion, Accountability, Communication, and Ethics (PACE)
What are the RHA shared values?
24 hours
What time frame should incidents be reported to Supervisor
Access East, Community Care of the Lower Cape Fear, Impact Health
What are the names of the 3 HOP networks?