DHHS has developed a reconsideration process for providers’ use following the validation of the provider submitted attestation information.
Topics Related to Medicaid Managed Care
New Long-Term Services and Supports Care Management web page, Advanced Medical Home Provider Manual 2.1 released and Program Guide added.
To assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program, NCDHHS generated a new Advanced Medical Home (AMH) NC Medicaid Direct/NC Medicaid Managed Care Primary Care Provider (PCP) Enrollee Report for distribution to CCNC/CA participating providers.
Key dates for transitioning to NC Medicaid Managed Care, Provider contracting reminders, Provider Playbook updates, Provider outreach to patient panels, webinars, Provider and health plan look-up tool, PHP quick reference guides, help center, Provider Ombudsman and Tailored Care Management certification.
NC Medicaid will offer time-limited payments to practices that have attested as an Advanced Medical Home Tier 3 if they can demonstrate successful readiness for AMH Tier 3 responsibilities.
The Department is releasing the draft Tailored Care Management Desk Review Guide and Scoring Tool to support providers applying for AMH+ or Care Management Agency certification.
Providing the most accurate and complete provider information is a top priority so Medicaid and NC Health Choice beneficiaries can make the most informed choice for their health plan and primary care provider.
Effective July 1, 2021, NC Medicaid will increase fee-for-service rates and establish rate floors for facility-based crisis and mobile crisis management services that will mandate minimum reimbursement rates.
An updated draft of NC Medicaid’s Managed Care Quality Strategy is posted for public comments until May 6, 2021.
NCDHHS has implemented a PCP practice reassignment process to better match beneficiaries to the PCP with whom they already have an active relationship with to help ensure the best health plan is selected during auto-enrollment.