• From the NC Medicaid 2021 Provider Playbook, you will find Updated FAQs on Medicaid Managed Care Claims and Prior Authorizations. Some examples of FAQ topics include: how to file a claim with each of the PHPs, what information is needed from the provider to file the claim,  portal messaging and how to submit prior authorizations to a health plan and many other topics.  There are helpful links and the PHP Claims Schedule through October 2021.
  

COVID-19 Clusters among Schools and Sports Teams

Join us for important Medicaid updates at the next Back Porch Chat on Medicaid Managed Care Hot Topics scheduled for Thursday, September 16 from 5:30-6:30 PM. Carrie Brown, MD, MPH Chief Medical Officer for Behavioral Health & IDD, NC Department of Health and Human Services will host the event

This series, formerly the Advanced Medical Home (AMH) Webinar Series, is designed to to support practice managers, quality improvement professionals, care coordinators, and others within your practice who are responsible for meeting the NC Medicaid Managed Care Provider requirements. All webinars are from 5:30-6:30 PM. Join us for one or for all!

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care health plans, will host a Virtual Statewide Primary Care Quality Forum to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives.

In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to providers who have not yet contacted with a PHP through Nov. 30, 2021. These flexibilities were originally expected to sunset on Aug. 30, 2021.   

DHHS and PHPs are aware of potentially delayed payments and increased claim denials during the transition period. Providers experiencing claim payment issues should initially work with the PHPs to address claim issues and avoid the need for a hardship advance. 

Back Porch Chat: Medicaid Managed Care Hot Topics

THURSDAY, AUGUST 19 | 5:30-7 PM

Hosted by Shannon Dowler, MD, Chief Medical Officer of the NC Division of Health Benefits, this 90-minute session welcomes each of the Chief Medical Officers of North Carolina's five Medicaid Managed Care plans to bring you late breaking information and guidance on NC Medicaid’s transition to Managed Care. Topics covered will include:

• Updates on Hot Topics
• Data Overview for Call Center & NEMT
• Common Claim Issues
• Common Reasons for Prior Authorization Denials
• Q & A

Do you have a question you would like Dr. Dowler or the PHP CMOs to answer during the webinar? Please access this link to enter your questions. We look forward to hearing from you!

During the transition period after NC Medicaid Managed Care launch, providers may experience payment issues from an increase in claim denials.  

What is the Request to Move to NC Medicaid Direct Process?