What You Need To Know from Medicaid Provider Update

NC Medicaid Division of Health Benefits posted a Medicaid Managed Care Provider Update on March 16, 2021. Below are some important highlights.

Key Dates for Transitioning to Medicaid Managed Care

March 15, 2021 – Open Enrollment begins
May 14, 2021 – Open Enrollment ends
May 15, 2021 – Auto Enrollment for beneficiaries who have not selected a health plan
May 22, 2021 (approximate) – Transition of Care information is sent to each health plan for beneficiaries assigned to that health plan
July 1, 2021 – Medicaid Managed Care launch

Provider Contracting Reminders

Medicaid In order for a provider’s information to be used in auto-enrollment (May 15, 2021), contracts should be executed with Health Plans by April 12, 2021. This allows sufficient time for signed contracts to be returned and for the Health Plan to process those contracts. Typically, Health Plan processing time is two to three weeks, but may take longer. Providers need to contract with health plans in a timely fashion to avoid losing patients when health plans assign beneficiaries to in-network providers. More information is available here. 

Tailored Care Management Certification

To continue supporting providers interested in obtaining certification as an Advanced Medical Home Plus (AMH+) practice or Care Management Agency (CMA), the Department extended the Round 1 application deadline from March 1, 2021 to June 1, 2021.  More information is available here.

New Resources

PHP Quick Reference Guides

NC Medicaid’s Managed Care Prepaid Health Plans (PHPs) have created quick reference guides to include the most current and comprehensive information for providers. Each quick reference guide covers: 