Today we bring you updates from North Carolina Division of Health Benefits...
Tailored Plan Panel Membership and Primary Care Provider List
To provide continuity of service to members and support the contracting efforts of Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans with primary care providers (PCPs), NC Medicaid is sharing this list of member counts for Advanced Medical Home (AMH) practices (by NPI + location code) affiliated with Tailored Plans as of Dec. 1, 2022.
The table [medicaid.ncdhhs.gov] published on the Provider Contracting with Health Plans webpage [medicaid.ncdhhs.gov] provides the following level of detail:
- NPI and Location Code
- Name of Provider
- Provider Address
- Tailored Plans of the members based on current member address
- Currently Assigned Panel Count of Members and their projected Tailored Plan. This number can change in future based on member eligibility at the time of actual enrollment with Tailored Plans.
Please note: providers who have a panel size of 10 members or fewer were not included in this list
This list provided is from an initial analysis and is intended to be used for Tailored Plan contracting purposes only. The Department expects the numbers of members assigned to each PCP/Tailored Plan to change at launch as new Members enroll in Medicaid, Members become Tailored Plan eligible, and as Tailored Plan eligibility is reassessed.
For more information, please see Tailored Plan Panel Membership [medicaid.ncdhhs.gov].
Learn more here: Provider Contracting with Tailored Plans
NCDHHS Sends Tailored Plan Enrollment Notices to Beneficiaries
On Aug. 15, 2022, eligible beneficiaries were automatically enrolled in one of six Behavioral Health I/DD Tailored Plans in anticipation of the program launch on Dec. 1, 2022. Until then, beneficiaries will continue receiving behavioral health, I/DD, substance use and traumatic brain injury (TBI) services as they do today.
The NC Medicaid Enrollment Broker is mailing notices this week to the beneficiaries who were automatically enrolled, and to those who have the option to enroll with a Tailored Plan. Notices are also being sent to beneficiaries’ authorized representatives.
The notices provide details about Tailored Plan enrollment, including:
- Name of the Tailored Plan in which the eligible beneficiary was enrolled and its Member and Recipient Services phone number
- Reminder that Tailored Plan benefits will begin Dec. 1, 2022
- Other available health care options for each beneficiary, as applicable
- How to select a primary care provider (PCP) and Tailored Care Management provider
- Contact information for the Enrollment Broker, which can provide choice counseling and make enrollment changes
A reminder to select a PCP and Tailored Care Management provider will be mailed in September. Beneficiaries with questions can contact the Medicaid Enrollment Broker at 1-833-870-5500 or visit ncmedicaidplans.gov [ncmedicaidplans.gov].
For more information on Tailored Plan enrollment, refer to the Tailored Plan Auto-enrollment and Choice Period [medicaid.ncdhhs.gov] fact sheet. Sample notices are on the NC Medicaid website under Beneficiary Notices – Enrollment Packet [medicaid.ncdhhs.gov].