Medicaid Managed Care: It’s Here….

It’s hard to believe the Medicaid Managed Care launch is upon us. The past year and a half we have experienced many challenges to be sure. You can rest assured your Northwest AHEC Practice Support team is here to help you navigate these changes. Below are some new resources NCDHHS has provided to help you and your practice as they launch Medicaid Managed Care.

Answers to your most frequently asked questions can be found in the NC Medicaid Managed Care Provider Update – June 29, 2021 Frequently Asked Questions for NC Medicaid Managed Care.

Recently updated factsheets in the Provider Playbook include:

Panel Management - June 29, 2021
Protections for Pregnant Women and Newborns - June 29, 2021
Day One Provider Quick Reference Guide - June 29, 2021
What Providers Need to Know: Part 2 – After Managed Care Launch - June 29, 2021

KEY DATES FOR TRANSITIONING TO NC MEDICAID MANAGED CARE

Aug. 30, 2021 – Last date by which the health plan will pay claims and authorize services for Medicaid-enrolled out of network providers equal to that of in-network providers (or until end of episode of care, whichever is less)
Sept. 29, 2021 – Last date by which the health plan must honor existing and active prior authorizations on file with North Carolina Medicaid or NC Health Choice (or until the end of the authorization period, whichever occurs first)
Sept. 30, 2021 – End of beneficiary choice period. *Exempt beneficiaries can change their health plan at any time. They can also choose NC Medicaid Direct at any time.

KNOW WHERE TO SUBMIT CLAIMS

If there are claims for dates of service prior to July 1, 2021, they should be submitted as they are today, through NCTracks or LME-MCOs. For dates of service beginning July 1, 2021, claims routing depends on a beneficiary’s enrollment at time of service and the services provided. Claims for beneficiaries enrolled in NC Medicaid Direct should continue to be submitted to NCTracks. Claims for members enrolled in Medicaid Managed Care should be submitted to the assigned health plan as shown on their member ID card and validated through the NCTracks Recipient Eligibility Verification methods, unless the service provided is a carved-out service. Two Claims Submission Provider Fact Sheets are available on the Provider Playbook that addresses how managed care claims are filed.

Managed Care Claims and Prior Authorizations Submission: What Providers Need to Know - Part 1 - June 14, 2021
Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions - Part 2 - June 14, 2021

PHP Quick Reference Guides

AmeriHealth Caritas North Carolina
https://www.amerihealthcaritasnc.com/provider/forms/index.aspx

Carolina Complete Health
https://network.carolinacompletehealth.com/resources/manuals-and-forms.html

Healthy Blue (Blue Cross Blue Shield)
https://provider.healthybluenc.com/north-carolina-provider/manuals-and-guides

United Healthcare Community Plan of North Carolina
https://www.uhcprovider.com/en/health-plans-by-state/north-carolina-health-plans/nc-comm-plan-home/nc-cp-training.html

WellCare of North Carolina
https://www.wellcare.com/North-Carolina/Providers/Medicaid

As always, if you have questions and need further assistance contact your Northwest AHEC Practice Support Team.

Chris Jones, DrPH, MHA 
Practice Support Team Lead 
336-713-7039
cjones@wakehealth.edu

Ryan D. Wilkins, BS 
Practice Support Coordinator 
336-816-5550
rdwilkin@wakehealth.edu

Medina Wilson, MBA-HM, CPC, CPPM, CFD 
Practice Support Coordinator 
336-618-0974
mewilson@wakehealth.edu

Tammy Yount, MSHAI, PCMH CCE
Practice Support Coordinator 
336-829-9641
tyount@wakehealth.edu