Medicaid Managed Care: Upcoming Deadline for Provider Contracts

For inclusion in open enrollment and auto-enrollment, provider contracts must be signed and mailed to health plan by: 

Feb. 1, 2021, for inclusion in open enrollment, and 

April 12, 2021, for inclusion in auto-enrollment. 

Why is it important to meet these deadlines? 

During open enrollment (March 15, 2021 through May 14, 2021) for Medicaid Managed Care, beneficiaries will choose a health plan and primary care provider (PCP). Those beneficiaries who do not make a choice will be auto-enrolled (commences on May 15, 2021 and runs for six days) in a health plan. 

These recommended provider contracting deadlines allow health plans to process provider contracts and ensure that provider records are loaded correctly and transmitted to our Enrollment Broker. This typically takes at least two to three weeks, but it may take longer. Additional time is then needed to transmit information to the Department for inclusion in the open enrollment and auto-enrollment processes. 

PCPs who do not contract with health plans by the deadlines risk losing patients, as beneficiaries will choose a PCP from the chosen health plan’s in-network providers, and health plans will auto-assign beneficiaries only with network providers. If a contract is not in place by July 1, 2021, and the provider has not engaged in good faith negotiations, the provider is at risk for being reimbursed at 90% of the current Medicaid fee for service rate and subject to additional prior authorizations. 

Still have questions?? 

For more information on contracting with a health plan, contact them directly. Contact information is available on the Medicaid Health Plan Contacts and Resources web page. 

Questions and answers relating to provider contracting deadlines are available on the Provider Contracting with Health Plans webpage. 

Resources:  

https://medicaid.ncdhhs.gov/blog/2020/11/19/provider-and-health-plan-contract-deadlines-inclusion-open-enrollment-and-auto