Medicaid Managed Care Back Porch Chat
Key Updates: Children and Families Specialty Plan (CFSP) Launch, HOP
Thursday, July 31 | noon-1p.m.
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Recent Posts
NC Medicaid published the 2025 NC Medicaid Standard Plan Performance Comparison Tool and accompanying Technical Guide. The new tool allows Medicaid beneficiaries to compare the performance of the five NC Medicaid Standard Plans.
The tool enables beneficiaries to make informed decisions about which Standard Plan works best for them. It provides easy-to-read comparisons of how the Standard Plans perform across different domains of health care, including: getting care, care experience, experience with providers, reproductive and sexual health, and children’s health. The complementary technical guide provides details on how NC Medicaid conducted the comparison, and where the data came from.
Here's one excerpt from the tool:
A Full Star means the health plan performed better than the average of all the Standard Plans
A Half-Filled Star means the health plan performed within the average of all the Standard Plans
An Empty Star means the health plan performed worse than the average of all the Standard Plans
Sources:
NC Medicaid Standard Plan Performance Comparison Tool 2025
NC Medicaid 2025 Standard Plan Performance Comparison Tool Technical Guide
The AHEC Standardized Onboarding and Credentialing program aims to improve the process of placing health science students in clinical placements through partnerships as well as onboarding and credentialing tools.
These tools help reduce the time and resources needed to onboard and credential students to clinical rotations. These tools, as well as support and guidance from AHEC and other partners, can make it easier for small practices to host students, helping to increase opportunities for training, and ultimately increasing clinical capacity. To get started or for more information, please contact Aubrey Delaney, Associate Director Onboarding and Credentialing at Audelaney@wakeahec.org.
Learn more: Standardized Student Onboarding and Credentialing.
From CMS:
CMS is committed to crushing fraud, waste, and abuse. The WISeR Model, which stands for Wasteful and Inappropriate Service Reduction, will help meet this goal, while supporting people with Original Medicare to receive safe and appropriate care and protecting federal taxpayers.
Through WISeR, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited process for reviewing the medical necessity of select items and services shown to have little to no clinical benefit and that are particularly vulnerable to fraud, waste, and abuse.
With this announcement, CMS has issued a Request for Applications (RFA) for companies interested in participating in the model.
Find more information on the WISeR Model webpage, as well as the model press release and factsheet.
Send questions about the model to WISeR@cms.hhs.gov.
WEBINAR OPPORTUNITY
Remote Patient Monitoring Optimization for FQHCs
June 25, 2025 | noon-1 p.m.
Join us for an exclusive training webinar hosted by NC AHEC Practice Support in collaboration with the NC Community Health Center Association. The training is designed specifically for federally qualified health center staff interested in optimizing or starting remote patient monitoring (RPM) as a solution for improved patient care. RPM is a new healthcare practice that uses digital devices to collect and transmit patient health data to healthcare providers. It allows for continuous monitoring and management of patient’s conditions from a distance. This healthcare practice can work successfully if implemented correctly.
This session will provide an overview of the latest trends, how to implement in your workflows, and appropriate Medicare/Medicaid billing codes to ensure financial sustainability and accuracy. Register now and take the first step in learning more.
Register for the RPM Webinar
Excerpt from CMS QPP Small Practices Newsletter:
2025 Consumer Assessment of Healthcare Providers Survey (CAHPS) for MIPS Survey Registration Now Open
Registration is open through June 30, 2025, at 8 p.m. ET for the CAHPS for MIPS Survey for the 2025 performance year.
Who can register?
- Groups, virtual groups, and APM Entities that intend to administer the CAHPS for MIPS Survey as 1 of their 6 quality measures for reporting traditional MIPS
- Groups, subgroups, and APM Entities that are registered to report the following MVPs and that intend to administer the CAHPS for MIPS Survey as 1 of their 4 quality measures:
- Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP
- Advancing Cancer Care MVP
- Value in Primary Care MVP
How to Register
Groups, virtual groups, and APM Entities will register on the QPP website. You’ll need to have the Security Official role to register your organization. Please refer to the QPP Access User Guide (ZIP, 4MB) for information about obtaining a Security Official role for your organization. To register:
- Sign in to QPP.
- Click Start Registration from the landing page.
- Click Register or Edit CAHPS Registration.
Subgroups interested in administering the CAHPS for MIPS Survey as 1 of their 4 required quality measures will need to complete their MVP registration prior to registering for the CAHPS for MIPS Survey. After completing the subgroup’s MVP registration, they will need to contact the QPP Service Center by email at QPP@cms.hhs.gov, by creating a QPP Service Center ticket, or by phone at 1‑866‑288‑8292 (Monday through Friday, 8 a.m. – 8 p.m. ET) to register for the CAHPS for MIPS Survey.
You must register by 8 p.m. ET on June 30, 2025.
Additional Resource
Complete one or both of the interactive, self-paced eLearning modules on your computer or mobile device. Earn free contact hours!
PART 1 - About 1 in 10 Americans have diabetes, with 90-95% of those having Type 2 Diabetes. (CDC) The majority of these people receive health care in the primary care setting (Pilla et. al). Physiologically, diabetes affects multiple organ systems, as well as the emotional well-being of the affected person. Medicine regimens can be complex, especially for an older person with other chronic conditions. To enable the practice staff to support the person with Type 2 Diabetes, this course uses case studies of familiar patients seen in primary care. Practical office-based clinical assessment and patient education concepts are presented. Basic pharmacology of diabetes drugs, laboratory tests used to assess and monitor the disease and common physical exam findings are covered. Register online at www.nwahec.org/75805
PART 2 - Managing diabetes requires much more than taking medicines and visiting the primary care provider’s office---lifestyle changes at the heart of a person’s very self are needed. People with diabetes are 2-3 times more likely to have depression than those without diabetes (CDC). Typically considered a lifelong chronic condition, Type 2 diabetes requires the affected person to incorporate it into their self-image and work every day on difficult behavior changes. Mood disturbances may also be the result of physiologic changes caused by the illness, or from medication side effects. Building on the foundation of Part 1 of this series, this module focuses on the impact a diagnosis of Type 2 Diabetes can have on the mental health of patients they see in primary care. Register online at www.nwahec.org/75808
Part 2 builds on the case study presented in Part 1, so you are encouraged (but not required) to take both modules.
There is no charge for either online course. Course registration is generously supported by the Division of Health Benefits.
NEW WEBINAR SERIES
NC Medicaid Provider Enrollment
NCDHHS-DHB Credentialing Committee Initiative Stakeholder Engagement Session#3
Please join NC AHEC and the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB), for the third stakeholder teleconference on June 25 from 2-3 p.m. to continue the discussion of a new initiative led in tandem with General Dynamics Information Technology (GDIT). This initiative will establish a Credentialing Committee aimed at maintaining a high-quality, ethical, and competent provider network to support NC Medicaid beneficiaries.
This third forum will offer stakeholders:
- A collaborative forum to discuss the committee’s future role in the provider enrollment and credentialing process to determine compliance of regulatory requirements by NC Medicaid provider applicants.
- A deeper dive into the roles of committee members.
- Status of committee bylaws.
- Review of frequently asked questions and answers pertaining to the development of this project.
These stakeholder engagement sessions will occur monthly, as follows, until the project implementation and are intended to be interactive as the Department values input from partnering stakeholders:
- June 25, 2025
- July 30, 2025
- August 27, 2025
- September 24, 2025
You are encouraged to submit your related questions and comments for targeted open discussion at the meetings to Medicaid.credcommittee.stakeholders@dhhs.nc.gov. We look forward to connecting with you!
We’re excited to share a new opportunity from SEAHEC: the Healthcare Mastery Series, a free three-part learning experience designed to strengthen your front office operations and clinical documentation practices.
This series offers practical tools and expert-led insights on:
- Front Office Professional– June 11 at 12 PM
- Point of Service Collections– June 18 at 12 PM
- Coding and Documentation: Revised Guidelines for Office and Hospital Evaluation and Management Coding– July 16 at 12 PM
Each session is a FREE, one hour and tailored to help your team enhance patient engagement, streamline workflows, and stay current with evolving standards in healthcare delivery.
You can register for any or all of the webinars.
For more details, see the brochure HERE.
