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.  

The third webinar in the Quality & Population Health Webinar series, formerly the Advanced Medical Home (AMH) Webinar series, will be held November 16 from 5:30-6:30 p.m. and will focus on PCP Assignments and Working with Clinically Integrated Networks (CINs). Following the presentations, there will be time for Q&A. This webinar series is designed to support providers, practice managers, quality improvement professionals, care managers, and CINs. We hope you can join us!

Please join NC Medicaid Chief Medical Officer (CMO) Dr. Shannon Dowler, along with all the NC Medicaid Managed Care plan CMO’s, for the October Back Porch Chat on October 21 from 5:30 - 6:30 p.m.

This webinar will review new COVID-19 surge response offerings from NC Medicaid, including a COVID-19 vaccine incentive program for NC Medicaid beneficiaries. It will also review how to help a patient who needs Behavioral Health and Individual Developmental Disabilities (I/DD) Tailored Plan behavioral health services move from a standard plan to NC Medicaid Direct.

In efforts at improving transparency, this webinar will provide an overview of a claims dashboard and clinical quality measures, and show results across plans in our first quarter of NC Medicaid Managed Care.

Finally, it will summarize the “latest and greatest” in recent Medicaid bulletins and answer your questions. Please use this link to submit your questions in advance.

Please join NC Medicaid Chief Medical Officer (CMO) Dr. Shannon Dowler, along with all the NC Medicaid Managed Care plan CMO’s, for the October Back Porch Chat on October 21 from 5:30 - 6:30 p.m.

This webinar will review new COVID-19 surge response offerings from NC Medicaid, including a COVID-19 vaccine incentive program for NC Medicaid beneficiaries. It will also review how to help a patient who needs Behavioral Health and Individual Developmental Disabilities (I/DD) Tailored Plan behavioral health services move from a standard plan to NC Medicaid Direct.

In efforts at improving transparency, this webinar will provide an overview of a claims dashboard and clinical quality measures, and show results across plans in our first quarter of NC Medicaid Managed Care.

Finally, it will summarize the “latest and greatest” in recent Medicaid bulletins and answer your questions. Please use this link to submit your questions in advance.

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.

This webinar will provide an overview of the Pilot program, with a focus on the essential roles and responsibilities of human services organizations that will provide Pilot services to eligible Medicaid members. The webinar will also highlight important upcoming implementation milestones and next steps. The session will be geared towards human services organizations that are interested in providing Pilot services, but is open to the public. There will be time reserved at the end for Q&A. 

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.  

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.   

Pediatric Practices who have not already signed up for the COVID-19 Vaccine Management System (CVMS) should have received an email from the North Carolina Department of Health and Human Services (NC DHHS) with important updates on the COVID-19 vaccine program.  See below for more details. 

Pediatric Practices who have not already signed up for the COVID-19 Vaccine Management System (CVMS) should have received an email from the North Carolina Department of Health and Human Services (NC DHHS) with important updates on the COVID-19 vaccine program. See below for more details.