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CONTACT INFORMATION

  • CONCERN AND COMPLAINT LINE 1-800-646-4518
  • PATHWAYS INFORMATION LINE - Updated message for staff and community during weather events and or other business interruptions 704-884-2545

CAP I/DD UTILIZATION REVIEW

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Beginning January 20, 2011, Pathways LME began conducting reviews for designated services related to Community Alternatives Program for Intellectual/Developmental Disabilities (CAP I/DD) services for all Medicaid Waiver Recipients whose Medicaid originated from counties in Smoky Mountain LME, Mental Health Partners, Mecklenburg LME and Pathways LME Catchment area. This includes authorization of services on initial Plans of Care (POC) as well as performance of the Continued Need Reviews (CNR), Revisions and Provider Changes.

   
How to Reach Us
Phone: 1-855-PATH-CAP (1-855-728-4227)
Fax:  1-855-PATH-FAX (1-855-728-4329)



Tools for Providers Submitting CAP I/DD Authorization Requests
  
  

   

 

North Carolina Medicaid

 

NC Medicaid Toll Free Number

1-888-510-1150

 

 

NC Medicaid FAX Numbers

 

Medicaid Mental Health/ Substance Abuse

877-339-8753

Medicaid Developmental Disabilities

877-339-8754

Medicaid Residential (Program & Family Type) and Retrospective Review

877-339-8757

 

Medicaid Psychiatric Residential Treatment Facilities (PRTF)

877-339-8760

 

     

 

You have two options for completing the Authorization Request form:

Option 1. CTCM (may be completed on your PC)

Option 2. CTCM (may be completed manually or on your pc and printed)

 

 

Required Documents for CAP Authorization Requests

   All Submissions must include:

  • Recipient’s Name
  • Date of Birth
  • Medicaid ID number
  • Provider’s Medicaid Provider number
  • Provider’s NPI number
  • Provider’s contact information
  • Description of requested service
  • Start date
  • Required signatures
  • Supporting documentation
  • Clinical information to determine Medical Necessity

 

  Initial and Concurrent Requests must include:

  • I/DD TCM contact information
  • Complete PCP with Crisis Plan
  • Current MR2
  • NC SNAP
  • Current Psychological
  • Supporting assessments
  • Cost Summary
  • CTCM   

 

  Revisions (adding, discontinuing or changing a service) must include:

  • PCP Update/Revision
  • Cost Summary
  • CTCM
  • Supporting assessments

 

  Change of Provider must include:

  • PCP Update/Revision
  • Cost Summary
  • CTCM to discharge previous provider
  • CTCM to add new provider

 

Additional CAP I/DD Information

 

  Waiver Manuals:

 

  Cost Summaries: Support (9/17/10) | Comprehensive (9/17/10)

 

 

 

  Links

 

 


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