Practice Support Update Blog

What You Need To Know from Medicaid Provider Update

Mar 17, 2021 4:00:00 PM / by Practice Support Team

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 

MedicaidIn 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:  

  • Provider Services Contacts; 
  • Provider Portal Information; 
  • Prior Authorization / Notifications Information; 
  • Member Services / Eligibility Information; 
  • Claims / EDI Information; 
  • Provider Grievances and Appeals Information; 
  • Non-Emergency Medical Transportation Information; 
  • Pharmacy Information; 
  • Nurse Line Information; 
  • Behavioral Health Crisis Information; 
  • Transportation Information; 
  • Interpreter Services Information; 
  • Vendor Information; 
  • Care Coordination Information; and 
  • Additional resources.  

AmeriHealth Caritas North Carolina 
https://www.amerihealthcaritasnc.com/provider/forms/index.aspx 

Carolina Complete Health 
https://network.carolinacompletehealth.com/resources/manuals-and-forms.html 

Healthy Blue (Blue Cross Blue Shield) 
https://provider.healthybluenc.com/north-carolina-provider/manuals-and-guides 

United Healthcare Community Plan of North Carolina 
https://www.uhcprovider.com/en/health-plans-by-state/north-carolina-health-plans/nc-comm-plan-home/nc-cp-training.html 

WellCare of North Carolina 
https://www.wellcare.com/North-Carolina/Providers/Medicaid 

 

Health Plan Training Resources for Providers 

For training resources, please visit the health plan training websites below: 

AmeriHealth Caritas North Carolina 
https://www.amerihealthcaritasnc.com/provider/training-and-education/provider-training.aspx 

Carolina Complete Health 
https://network.carolinacompletehealth.com/resources/education-and-training.html  

Healthy Blue (Blue Cross Blue Shield) 
https://provider.healthybluenc.com/north-carolina-provider/training-academy 

United Healthcare Community Plan of North Carolina 
https://www.uhcprovider.com/en/health-plans-by-state/north-carolina-health-plans/nc-comm-plan-home/nc-cp-training.html  

WellCare of North Carolina 
https://www.wellcare.com/en/North-Carolina/Providers/Medicaid/Training/Medicaid-Training  

 

 

Tags: Medicaid, Medicaid Managed Care

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