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.
The Medicaid Managed Care webinars on the 1st and 3rd Thursday of the month are dedicated to bringing you late breaking information and guidance on NC Medicaid’s transition to Managed Care. Topics will vary, but each session will include an open question and answer period.
On May 26, 2021, The North Carolina Department of Health and Human Services (NCDHHS) announced that all Medicaid beneficiaries currently eligible to transition to managed care have selected or been assigned a health plan with 97% enrolled in a plan that includes their current primary care provider (PCP) in network.
NCDHHS recently released a fact sheet on Panel Management. We pulled some highlights from the fact sheet for you on the blog today.
Advocates and partner agencies can learn more about next steps in the NC Medicaid Managed Care rollout, with a focus on what people with Medicaid should expect next and how the Ombudsman can help.
Tuesday, May 25, 2021
12 – 1 p.m.
HOW CAN I SEE WHICH BENEFICIARIES ARE ASSIGNED TO ME?
Once the beneficiary has been assigned to the PCP/AMH, a provider can see these assignments by:
- Working with your contracted health plan
- Accessing information through the NCTracks Provider Portal
- Using the Recipient Eligibility function in NCTracks to verify this information for a single beneficiary.
- Using the NCTracks batch eligibility verification function.
- If you are an AMH, you can review the beneficiary assignment file you will receive from the health plan.
Providers cannot currently view their assigned beneficiaries as a list in NCTracks. DHHS will announce new functionality prior to the launch of NC Medicaid Managed Care, where providers will receive a monthly report to view the beneficiaries assigned to them.
NCDHHS Extends Open Enrollment for Medicaid Managed Care through May 21, 2021. Read about it in this announcement.
In NC Medicaid Managed Care, most beneficiaries choose their health plan and primary care provider (PCP) or Advanced Medical Home (AMH), which is a type of primary care provider. During open enrollment from March 15 through May 21, 2021, beneficiaries will enroll in a health plan and select their PCP/AMH. If a beneficiary does not select a health plan, they will be automatically enrolled in one by the NC Department of Health and Human Services (DHHS). If a beneficiary does not select a PCP/AMH, then the health plan will assign one to them. First, DHHS will auto-enroll the beneficiary in a health plan. Once the health plan receives the beneficiary information, the health plan will auto-assign a PCP/AMH to the beneficiary.
The Advanced Medical Home webinar series provides Medicaid primary care practice staff and clinicians with more information on North Carolina’s AMH model and how to function at the highest AMH Tier possible when Medicaid Managed Care goes live in July 2021. This webinar, the last in this series, will provide a review of the Advanced Medical Home requirements, update on the glide path payments and more.
THURSDAY, MAY 13 | 5:30–6:30 PM
Advanced Medical Home Refresher
The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC are offering a bimonthly evening webinar series to help prepare providers, practice managers, and quality managers for Medicaid Managed Care going live on July 1, 2021.
As a reminder, once an AMH Tier 3 practice has attested to meeting Glidepath payment eligibility in NCTracks, DHHS will validate that the practice is enrolled with NC Medicaid and attested as an AMH Tier 3 practice. DHHS then confirms the attestation with the respective pre-paid health plans in order to validate that each Tier 3 practice has met contracting and testing criteria.
