TCM Technical Support Education Series

Description

NC DHHS has developed partnerships with North Carolina Area Health Education Center (NC AHEC) to provide practice support, technical assistance, and continuing professional development to help Tailored Care Management providers who have applied and passed the desk review in the transition to Tailored Care Management. The TCM Continuing Professional Development programs are designed to assist TCM care managers, supervisors and extenders with evidenced-based practices in all treatment settings for the successful implementation of TCM.

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Description: The Behavioral Health (BH) and Intellectual/Developmental Disability (I/DD) Tailored Plan (TP) Contract and the Prepaid Inpatient Health Plan (PIHP) Contracts are the primary sources for BH I/DD TP, PIHP, and Tailored Care Management (TCM) data exchange and health information technology requirements. BH I/DD T+B56Ps, or PIHPs will be expected to share the following data in a machine-readable format with Advanced Medical Home + (AMH+) practices, and Care Management Agencies (CMA), or their designated Clinically Integrated Networks (CINs), or Other Partners, for their attributed members to support Tailored Care Management:

• 1. Beneficiary assignment info, including demographic data and any clinically relevant and available eligibility info.


• 2. Pharmacy Lock-in data


• 3. Member claims/encounter data, including historical physical (PH), behavioral health, and pharmacy (Rx) claims/encounter data with new data delivered monthly (PH/BH) or weekly (Rx).


• 4. Acuity tiering and risk stratification data. BH I/DD TPs or PIHPs will receive an acuity tier (e.g., low, medium, high) from the North Carolina Department of Human Services (the Department); BH I/DD TPs or PIHPs are required to transmit acuity tier to AMH+ practices/CMAs (and results & methods of any risk stratification they conduct).


• 5. Quality measure performance information at the practice level.


• 6. Other data to support Tailored CM (e.g., previously established care plans, ADT data, historical member clinical info).

To streamline information exchange, reduce costs and administrative burden for all stakeholders, the Department has developed standard file layouts to assist with the exchange of most of the data required for effective Tailored Care Management.

Based on TCM Provider feedback post-TCM launch, the Department has implemented many enhancements to the TCM Data Interfaces to allow more streamlined data exchanges, provide necessary data elements, and optimize data ingestions. Through the TCM Data Interfaces Education Series, the Department aims to re-educate TCM Providers about the various TCM Data Interfaces and enhancements that have been put in place such as: consolidated TCM Data Interfaces across PIHP and TP (at TP launch), End of Month Beneficiary Assignment file, and Population Segment field additions on the Patient Risk List.

This course is not intended for sale. It is for certified AMH+/CMA providers and Tailored Plans only. A discount code to allow free access will be provided to you by your agency administrator. CINs and other agencies providing comprehensive care management that do not have a contract with MAHEC do not receive these courses for free. To contract with MAHEC, please contact Scott Melton.

By registering for this course, you are granting permission for your contact information and course completion information to be shared with NC DHHS-DHB and participating NC BH/IDD Tailored Plans for this continuing education activity.

Faculty:
NC DHHS, Division of Health Benefits

Hosted by:
Scott Melton, M.Div

Provided by

A program of

An approved program of

Target Audience

TCM certified AMH+/CMA employees only, including TCM supervisors, care managers, extenders and/or their affiliated CINs/Data Partners. A discount code to allow free access will be provided to your agency administrator by your NC AHEC practice support coach.

Objectives

Participants will be able to:

• Provide updated information about the TCM Data Interfaces
• Specify updates on TCM Data Interfaces enhancements
• Re-educate field on existing interfaces including their data scope, file delivery, transmission, and file naming convention
• Review common scenarios encountered as members transition between PIHP, TP programs, and explore how they should be handled through the consolidated TCM Data Interfaces