Get Connected

 Through Tailored Care Management, Behavioral Health I/DD Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all of their needs, spanning: physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS) and unmet health-related resource needs.  

https://files.nc.gov/ncdma/Provider-Webinar-AMH-CMA-Certification-12.17.2020.pdf

 The North Carolina Health Information exchange, NC HealthConnex, is a digital tool that gives providers a holistic view of their clients’ medical records, including things like allergies, diagnoses, medications, and more. All providers who accept state based insurance plans within the state of North Carolina are required to enroll in the NC HealthConnex by January 1st, 2023.  

https://hiea.nc.gov/

 The term “best practices” refers to Evidenced-based practice (EBP). EBP means evidence based on findings from empirical studies using the scientific method that emphasizes the integration of clinical expertise, patient values, and the best research evidence available in the formation of patient care decisions. 

https://www.samhsa.gov/resource-search/ebp

https://www.rtor.org/best-practices-treatments-that-work/

 The NC Health Information Exchange Authority's participation agreement requests that EHRs be minimally capable of sending HL7 messages, version 2 or higher. The first step is to have the ability to send HL7 messages (version 2.0 or higher) to enable the technical connection and data submission to NC HealthConnex. EHR products that are ONC certified for meaningful use for the for Centers for Medicare & Medicaid Services Incentive Programs are preferred. 

https://hiea.nc.gov/providers/electronic-health-record-vendor-connectivity-report

 Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. Communicating with health insurance companies is a key component of RCM. Implementing RCM, healthcare providers can more easily identify where errors are occurring within the revenue cycle. This decreases the likelihood of claim denials and increases payment.

https://www.businessintegrityservices.com/blog/steps-in-revenue-cycle-management  

Data analyses can reveal individual services you can try to negotiate fees for. Payers generally don’t grant fee increases across the board, but you can deliver your argument targeting specific services to the health plan’s provider relations representative, who can forward it to a network manager or contracting manager. To learn the required steps for contract negotiation, join Resource Connections Provider Association Inc. Members have free access to trainings posted on our website.

https://resourceconnectionsinc.info/get-conneted