Healthy Blue, an NC Medicaid Pre-Paid Health Plan, has updated its Healthy Blue Provider page to include a 'Known Issues Bulletin' of issues the PHP is working to resolve.
Unsure whether to file claims with NC Medicaid ID numbers vs. Pre-paid Health Plan member numbers? We've contacted the PHPs in our region and have info!
This series, formerly the Advanced Medical Home (AMH) Webinar Series, is designed 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!
Thursday, February 24 | Evaluating Medicaid Transformation
Thursday, March 24 | COVID-19 Vaccination in the Medicaid Population
Thursday, April 28 | Topic coming soon!
Thursday, May 26 | Topic coming soon!
Save the date and join in on Thursday, January 20 for the next webinar on Medicaid Managed Care "Hot Topics".
The North Carolina Department of Health and Human Services (NCDHHS) transitioned most
Medicaid beneficiaries to NC Medicaid Managed Care (Standard Plans) on July 1, 2021.
The North Carolina Department of Health and Human Services (NCDHHS) today published summary network adequacy results for Standard Prepaid Health Plans (Standard Plans) which were in effect for the July 1, 2021 “go-live." Network adequacy measures the ability of each NC Medicaid Managed Care health plan to deliver covered benefits by providing adequate access for members to all covered health care services through a network of contracted health care providers. Network adequacy and accessibility standards help verify that members have access to providers and offer an important tool for NC Medicaid to monitor and measure that access.
Provider appeal rights defined in the Standard Plan Contract Section V.D.5 Provider Grievances and Appeals, and the appeal processes outlined in the Prompt Payment Fact Sheet, include deadlines to submit appeals which may vary by Standard Plans, from 30 days to 365 days after the decision giving rise to the right to appeal.
North Carolina AHEC now offers you additional communication tools regarding Medicaid Managed Care challenges. If you are in need of an effective way to communicate complicated issues to the Prepaid Health Plans (PHPs), your Clinically Integrated Network (CIN), or even to the Provider Ombudsman, we can help.
The next webinar in the Quality & Population Health Webinar series will be held December 9 from 5:30-6:30 p.m. and will focus on Advanced Medical Homes: Incentives Plan.