TO: Providers for Medicaid Services in Partners BHM Catchment Area

DATE: October 23, 2012

TO: Providers for Medicaid Services in Partners BHM catchment area

FROM: Provider Network, Contracts, & IT

REASON: Access to Alpha MCS Provider Portal

Partners Behavioral Health Management is the LME-MCO covering Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin counties. Beginning January 1, 2013 Partners BHM will begin managing Medicaid services for our eight counties. Medicaid Providers will use the Alpha MCS system for entry of Treatment Plans, Service Authorization Requests and billing for dates of service beginning January 1, 2013. Providers must attend training for the Alpha MCS system prior to getting log in ID’s assigned for entry into the Provider Portal. Please follow the below processes for requesting access to the Alpha MCS Provider Portal AFTER you have attended the training offered by Partners BHM. The training calendar is posted on our website at www.partnersbhm.org.

Each provider must have one point of contact for Alpha MCS log in requests. In the event your agency spans across several counties and you have multiple regional managers, your agency may request to have more than one point of contact. The point of contact person will be responsible for submitting the Alpha log in requests for staff that need access. This would apply to staff members who need access to the Alpha system for entry of billing, Treatment Plans, Authorizations or other areas as applicable.

Please send an email to after attending the Alpha trainings, listing the provider agency name and the point of contact person(s) with contact # for said provider. Also, each agency must inform Partners via the above email if the point of contact person changes and appoint a new point of contact person.

Use the following form to notify Partners of staff needing log in ID’s. The forms should be sent to the email . The point of contact person MUST notify Partners of staff who no longer need access to the Alpha system, so their log in ID’s can be disabled for security purposes. If you do not submit a point of contact person, your agency will not receive log-in ID’s for the Alpha MCS system. This means you will not be able to enter Treatment Plans, Authorizations, or billing; meaning your agency will not receive reimbursement for Medicaid services beginning with January 1 dates of service for the stated counties above.

The Alpha log In Request form will be located on our website at www.partnersbhm.org, in the Providers section. The form should be completed online and emailed to: . Thank you for your prompt attention to this very important request. Please allow at minimum 2 weeks for processing your request.

Staff Log In Request for Alpha MCS

Form must be completed in its entirety for licensed staff in order for agency to bill for services.

**Provider Agency Name:

**Staff Name: Hire Date: Term Date:

**Phone Number:

**Agency Site Street Address (where services occurring):

**City: **State: **Zip+4:

**County: E-mail Address:

**Individual Staff Medicaid #:

**Individual Staff NPI #:

**License Type (if applicable): CNP CNS CSAC LCAS LCSW LMFT LMHC

LMHP LPA LPC LPN LSW MA MD MS MSW NP NS

PA PhD Psy.D PT RN SLP SLPA Other ______

**License State: #: License Expiration Date:

License State: #: License Expiration Date:

** denotes REQUIRED fields

For Partners Use Only:
IPRS Registration ID: ______/ Has Provider attended Alpha training? ______
Staff Registration ID: ______
Other: ______/ Contract in place? _____
OR Provider active in Alpha? ______

Forms should be completed online and emailed to:

Revised Form—Posted to Partners BHM website on 11/15/12