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

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.  

This is a friendly reminder that there are only four months left to apply for a final payment of up to $8500 from the NC Medicaid EHR Incentive Program [medicaid.ncdhhs.gov].  

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. 

With Medicaid Transformation comes the introduction of new points of contact for beneficiaries, such as the Enrollment Broker and health plans. A long-term goal of NC Medicaid is to provide a single point of contact – one number – for beneficiaries to call for assistance. For now, please try to direct beneficiaries to the appropriate contact using the information provided in this guide. The attached tables provide the various points of contact, key responsibilities, and phone numbers and/or websites beneficiaries can use.  

All Carolina Access Providers who received health equity payments are asked to take 5-10 minutes to complete this survey by July 16, 2021. The survey allows DHHS to monitor and evaluate how these payments were used. 

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 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. 

In December 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Quality Payment Program Final Rule that includes the new MIPS Promoting Interoperability Health Information Exchange Bi-Directional Exchange (PI_HIE_5) measure. 

This measure allows eligible clinicians or groups to attest that they are engaged in bidirectional exchange with an HIE to support transitions of care as an alternative to meeting the Support Electronic Referral Loops by Sending Health Information AND the Support Electronic Referral Loops by Receiving and Reconciling measures (PI_HIE_1 and PI_HIE_4).

Learn more about how to meet this measure at the NCHIEA Teletown Hall on Wednesday, May 26, 2021, at 12 p.m.

Practice Consultant Terri Roberts from Area Health Education Centers (AHEC), will discuss: the new QPP/MIPS measure; its meaningfulness to practices; and how NC HealthConnex can help with attestation. 

Register Here [hiea.nc.gov]