Interested in becoming a Network Provider with Alliance Health? Our Credentialing and Enrollment page provides everything you need to know.
Credentialing Process Update:
On November 18 a virtual training was held to introduce providers to the new process flow for Initial LP Credentialing applications effective December 1, 2020. Please review this FAQ for details.
- [toc]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.
- 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@AllianceHealthPlan.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.
Guidance regarding NCTracks Enrollment and Alliance Credentialing
Alliance strongly recommends that providers and sites that are currently going thru the Alliance credentialing process and any future enrollment/credentialing requests and are not currently enrolled in NCTracks to enroll in NCTracks effective immediately. Alliance will not be able to enroll providers in Alpha until the provider is successfully enrolled in NCTracks.
Alliance will continue to credential providers. Providers may receive two notification letters from Alliance. A provider will receive a credentialing letter once a credentialing decision has been made. However, if a provider is not enrolled in NCTracks the provider will not be enrolled in Alliance and entered into Alpha until the provider is successfully and correctly enrolled in NCTracks. Providers are responsible for notifying Alliance at Enrollment@AllianceHealthPlan.org once they are enrolled in NCTracks. The provider will receive a separate enrollment notification from Alliance once Alliance is able to confirm verification that the provider is enrolled correctly in NCTracks. If a provider is enrolled in NCTracks at the time the credentialing approval is completed they will receive only one letter, a Credentialing/Enrollment approval letter.
Access Credentialing and Enrollment Changes.
Providers and organizations participating in the credentialing and re-credentialing process have certain rights. Provider/organizations rights are as follows:
- Providers and organizations applying have the right to review information obtained from outside sources used to support an application. This does not include references, recommendations, or peer-protected information.
- Providers and organizations applying have the right to correct erroneous information from other sources. Erroneous information must be corrected in writing via email to the Credentialing Specialist within 7 calendar days from notification.
- Providers and organizations applying have the right to be informed of their application status upon request. Providers/organizations can request status updates from their assigned Credentialing Specialist via phone or email. Credentialing Specialists may provide status updates on missing information from an application packet, results of background checks, and an estimated time frame for credentialing to be sent to the Credentialing Committee through encrypted email to providers/organizations.
- Email CredentialingApps@AllianceHealthPlan.org to receive updates to a previously submitted application.
Members of the Alliance Provider Network are required to purchase and maintain certain types and amounts of insurance from a company licensed and authorized to do business in the State of North Carolina by the North Carolina Department of Insurance. Get full details on the insurance requirements and see below for special additional information for specific groups of providers.
Professional Liability Insurance Requirements for Agencies and Groups that Provider Outpatient Therapy
- 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 lists 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
- If the agency/group covers the practitioner (contractor) under a vicarious liability policy, the practitioner is required to have their own individual policy that meets the professional liability criteria ($1 million to $3 million).
Important Information for LIPs in Solo Practice Concerning Comprehensive General Liability Insurance
To be in accordance with Alliance’s contract with the State all contracted LIP solo entities will be required to purchase and maintain Comprehensive General Liability Insurance which includes Bodily Injury and Property Damage Liability Insurance protecting the provider and any employee performing work under the Contract from claims of Bodily Injury or Property Damage arising from operations under the Contract for an amount of not less than $1,000,000.00 per occurrence/$3,000,000.00 annual aggregate. Contracts will not be renewed for providers that do not submit this required insurance information. Any new LIP Solo providers initially credentialed and/or contracted with an effective date after October 25, 2017 will be required to have this coverage to meet credentialing and contracting requirements. Questions can be submitted by email.
Notifying Alliance of Changes in Business Operations
All providers are required to notify Alliance at ProviderNetwork@AllianceHealthPlan.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. Please complete a Notice of Change Form indicating any changes and submit to ProviderNetwork@AllianceHealthPlan.org.
What is the process for adding a clinician to my agency?
- Agency sends the completed Request to Add Clinician to ProviderNetwork@AllianceHealthPlan.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 and 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.
1. If the LP is not fully enrolled with NCTracks (affiliation with agency and appropriate DMH/Medicaid Benefit Plan chosen) they will not be linked with the requesting provider until NCTracks Enrollment is complete and verified.
2. If the LP is fully enrolled with NCTracks, the Credentialing Specialist will then link them to the agency in Alpha based either on the date Alliance received the completed enrollment packet or the date of enrollment in NCTracks, whichever comes last.
- 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 the Council for Affordable Quality Healthcare (CAQH) database to determine if the LP is already registered with CAQH. If the LP is registered with CAQH:
- Provider Network Operations will add them to the Alliance CAQH roster
- 2. The CAQH application must be current (dated within 14 calendar days) and complete.
- If the LP is not registered with CAQH, Provider Network Operations will email the requesting 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 credentialing 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 credentialing enrollment packet will be rejected and returned to the provider with an explanation of what is missing/incomplete.
- 5. If the credentialing 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 credentialing 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 accepted or the LPs effective date in NCTracks, whichever comes last.
- The LP packet will be forwarded to a Credentialing Specialist 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 credentialing 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 Credentialing Committee makes a decision the agency and the LP will receive written notification of the Committee’s decision.
What are the credentialing requirements for Nurse Practitioners, Psychiatric Nurse Practitioners, and Physician Assistants?
In addition to DMA Clinical Coverage Policy 8C requirements, Alliance that Psychiatric Nurse Practitioners, Nurse Practitioners and Physicians Assistants who are credentialed with Alliance have a supervision agreement with a licensed Psychiatrist. Alliance maintains this and other credentialing requirements to help ensure that our providers have the appropriate experience and psychiatric oversight to best serve our enrollees.
Does Alliance credential and enroll non-psychiatrist MDs?
Alliance operates a closed network and is credentialing and enrolling only MDs that are psychiatrists. Alliance maintains this and other credentialing requirements to help ensure that our providers have the appropriate experience and psychiatric training to best serve our enrollees.
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 as Current Service Needs on the home 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, clinicians 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.
Alliance conducts re-credentialing of all our credentialed providers at a minimum every three (3) years. It is Alliance’s goal to notify providers of their re-credentialing due date a minimum of 4 months prior to the due date. It is the provider’s responsibility to ensure that Alliance has the most current, updated contact information so that information may be received in a timely manner.
Network providers will have thirty (30) days from the date they receive their re-credentialing application packet to submit their completed application packet. Technical assistance is available to assist with any ongoing questions during the process.
- 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 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 will not 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 may be asked for during the re-credentialing:
- 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 (if applicable) needs 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, if applicable.
- List of all LME/MCOs that you have a contract with, if applicable.
- Copies of all Facility and/or Service Licenses for sites credentialed by Alliance, if applicable.
- Ensure Secretary of State document filings are up to date (corporate address), if applicable.
- 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 individuals. ($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 Health’s name and address should be listed as the Certificate Holder.
- Submit a current LP roster (if applicable).
- Submit an annualized budget, and 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 there are 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 must be included.