• From the NC Medicaid 2021 Provider Playbook, you will find Updated FAQs on Medicaid Managed Care Claims and Prior Authorizations. Some examples of FAQ topics include: how to file a claim with each of the PHPs, what information is needed from the provider to file the claim,  portal messaging and how to submit prior authorizations to a health plan and many other topics.  There are helpful links and the PHP Claims Schedule through October 2021.
  

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. 

NCDHHS recently released a fact sheet on Panel Management.  We pulled some highlights from the fact sheet for you on the blog today. 

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.   

Providers with Denials for Healthy Opportunities Screening, Assessment and Referrals Claims due to Edit 02088 May Now Resubmit Claims 

On Wednesday April 14th, 2021 NCDHHS posted  Provider Data Updates highlighting the importance of ensuring provider data is correct in NCTracks.  Please see important highlights below and click on the links for more complete information. 

Advanced Medical Homes Tier 3 “Glidepath” Payments Update   

In February, NC Medicaid announced that effective April 1, 2021, NC Medicaid will offer time-limited payments to practices that have attested as an AMH Tier 3 provider as part of the transition to Medicaid Managed Care. 

The NC Department of Health and Human Services recently released the Advanced Medical Home (AMH) Provider Manual 2.0. This version reflects program expectations as well as recent program modifications and changes that impact provider contracts. It replaces the prior version issued on Dec. 12, 2019.  
 

Notice Date: Feb. 1, 2021