The NC Department of Health Benefits and the Enrollment Broker have received many inquiries from NC Medicaid Direct beneficiaries who have indicated they were denied services because their provider did not accept NC Medicaid Direct.
Practice Support Team
Recent Posts
"NC Medicaid Direct" = Traditional Fee-for-service Medicaid
Jan 5, 2022 8:30:00 AM / by Practice Support Team
Using Z-codes to Document Social Determinants of Health
Jan 4, 2022 2:30:00 PM / by Practice Support Team posted in Social Determinants of Health, Primary Care
The Z-codes Z-55-Z-65 are used to document data related to issues a person faces related to where they are born, live, learn, work, play, and age. One's physical environment, and social, and economic factors significantly affect how long and well we live---much more than clinically provided health care. As you begin to screen your patients and uncover these factors, it is vital to codify what you have learned through the use of these z-codes.
NCDHHS Publishes Summary of Initial Network Adequacy Results for Standard Plans
Jan 4, 2022 12:36:32 PM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, Primary Care
The North Carolina Department of Health and Human Services (NCDHHS) today published summary network adequacy results for Standard Prepaid Health Plans (Standard Plans) which were in effect for the July 1, 2021 “go-live." Network adequacy measures the ability of each NC Medicaid Managed Care health plan to deliver covered benefits by providing adequate access for members to all covered health care services through a network of contracted health care providers. Network adequacy and accessibility standards help verify that members have access to providers and offer an important tool for NC Medicaid to monitor and measure that access.
During the holiday season, our thoughts turn gratefully to our partners who have made our success possible. It is in this spirit that we say thank you and best wishes for the holidays and New Year!
Deadline for EUC Application Closes 12/31/21
Dec 15, 2021 1:52:00 PM / by Practice Support Team posted in MACRA, MIPS, quality payment program
Given the public health emergency, participants in the Quality Payment Program may find it difficult to meet the requirements for the Merit-based Incentive Payment System (MIPS) for program year 2021.
Updates and Immunization Site Trainings offered by Pfizer
Dec 15, 2021 8:30:00 AM / by Practice Support Team posted in COVID-19, Primary Care, Pediatrics, Vaccination, immunization
With a goal to educate medical providers and health care immunization teams on the most recent medical updates regarding the Pfizer vaccine, Pfizer is hosting free online webinars.
Extension to NC Medicaid Managed Care Appeals Deadlines
Dec 14, 2021 1:24:58 PM / by Practice Support Team posted in Medicaid Managed Care, NCDHHS
Provider appeal rights defined in the Standard Plan Contract Section V.D.5 Provider Grievances and Appeals, and the appeal processes outlined in the Prompt Payment Fact Sheet, include deadlines to submit appeals which may vary by Standard Plans, from 30 days to 365 days after the decision giving rise to the right to appeal.
Medicaid Managed Care: New Communication Tools
Dec 14, 2021 8:00:00 AM / by Practice Support Team posted in Medicaid Managed Care, communication
North Carolina AHEC now offers you additional communication tools regarding Medicaid Managed Care challenges. If you are in need of an effective way to communicate complicated issues to the Prepaid Health Plans (PHPs), your Clinically Integrated Network (CIN), or even to the Provider Ombudsman, we can help.
Don't Forget - Quality & Population Health Webinar TODAY
Dec 9, 2021 7:00:00 AM / by Practice Support Team posted in Medicaid Managed Care, Quality Improvement
The next webinar in the Quality & Population Health Webinar series will be held December 9 from 5:30-6:30 p.m. and will focus on Advanced Medical Homes: Incentives Plan.
Join In To Celebrate National Influenza Vaccination Week
Dec 7, 2021 8:44:12 AM / by Practice Support Team posted in Vaccines, cdc
National Influenza Vaccination Week is here! If you haven’t received a flu shot yet, there’s still time. People with certain chronic conditions are more likely to develop serious flu complications. Together, we can all #FightFlu. Protect yourself and your loved ones by getting a flu shot.
