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Clinical Support Department
The Clinical Support Department consists of a Director, the PBH Senior Psychologist, three Social Research Assistants, the Appeals Coordinator and a Data Specialist. The main functions of this Department include:
- Enrollment reviews and verification
- Medicaid Verification
- Researching Medicaid loss reports, missing data reports and duplicate client reports
- Assist/troubleshoot system issues related to enrollment and TAR submission
- Coordinate research on claim kick outs and denials and ensure that corrections are submitted
- Utilization Management lead for IPRS
- Coordinate research on IPRS error reports
- Ensure data integrity related to Target Populations
- LME lead for NC TOPPS
- Data oversight for UM/Access Departments
- Clinical Reporting as required by DMH, DMA, CQI, and NCQA
- Clinical Staffing
- Adverse decisions on Medicaid and State funded service requests
- Responsibility for monitoring and trending of Appeals
- Monitor and request enhancement to the PBH CI system to maintain compliance with Local, State, and Federal regulations
Staff in Clinical Support Department:
- Kevin Davidson – Director of Clinical Support
- Sherry Vance - Social Research Assistant II - UM IPRS Lead
- Kelly Shepherd Ingram - Social Research Assistant II - NC TOPPS Lead
- Crystal Corntassel - Social Research Assistant II - Enrollment & Eligibility/Data
- Natalie Long - Data Specialist
- Dr. Carroll Lytch - Senior Psychologist
- Tina Santiago - Appeals Coordinator
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