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:
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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?
Prepaid Health Plan Information Added to NCTracks Automated Voice Response System
As part of recent NC Medicaid Managed Care updates, NCTracks accepts beneficiary enrollment and eligibility inquiries through the Automated Voice Response System (AVRS) which can be reached at 800-723-4330. The AVRS response includes the Prepaid Health Plan (PHP) name, contact information and the PHP assigned Primary Care Provider (PCP)/Advanced Medical Home (AMH). The response also includes a reminder that all care must be coordinated through the PHP.
To provide some clarity on prior authorization submissions, NCDHHS issued a NC Medicaid Managed Care Provider Update on Friday July 9, 2021 that includes information about claims submission and prior authorizations under Medicaid managed care.
Check out these upcoming webinars...
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.
