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SPECIAL BULLETIN: Approved PHP Provider Contracts as of June 7, 2019

Monday, June 10, 2019

The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.

The Department announces the approval of the following provider contract templates:

The Department is continuing to review other Provider contracts for PHPs. As the Department approves other provider contract templates, the Department will update this list and issue updated notices.

PHPs are permitted to utilize draft Provider contract templates until the Department approves the templates. Providers who are considering contracting with a PHP or who are in contract negotiations with a PHP should discuss with the PHP how to access the approved contract templates.

In accordance with Section 5.(6)d. of Session Law 2015-245, except as otherwise allowed under the State Contract, a PHP shall not exclude eligible providers from its network except when a provider fails to meet the PHP’s Objective Quality Standards or refuses to accept network rates (which shall not be lower than any applicable rate floors).

Author: 
NC Medicaid Provider Contracts, (919) 527-7021