Author: GDIT, (800) 688-6696
On Nov. 19, 2019, North Carolina suspended the implementation of Medicaid Managed Care. Managed Care policy papers, fact sheets and other documents and information include content that was effective when published and may not reflect changes in timing, schedules and other details due to the suspension. Please direct questions about Managed Care to the Medicaid Contact Center at 888-245-0179.
For inclusion in auto-enrollment, provider contracts must be signed and mailed to health plans no later than Nov. 15, 2019.
During open enrollment for Medicaid Managed Care, most beneficiaries will choose a health plan and primary care provider (PCP). Those who do not make a choice will be auto-enrolled in a health plan.
Medicaid has traditionally experienced high provider enrollment rates, which we want to continue. The November 15 deadline allows health plans to process provider contracts and ensure that providers can be paid; this typically takes at least two to three weeks, but it may take longer. Additional time is then needed to transmit information to the Department for inclusion in the auto-enrollment process.
PCPs who do not contract with health plans by November 15 risk losing patients, as health plans will enroll beneficiaries only with network providers. If a contract is not in place by Feb. 1, 2020, and the provider has not engaged in good faith negotiations, the provider is at risk for being reimbursed at 90% and subject to additional prior authorizations.
Health systems and providers are strongly encouraged to continue contract negotiations with health plans and finalize contracts as soon as possible. Once contracts are executed, health systems and providers become in-network providers with that health plan.
For more information on contracting with a health plan, contact them directly. Contact information is available on the Medicaid website at https://medicaid.ncdhhs.gov/health-plan-contact-information.
As open enrollment continues, please keep sharing what is working and what is not. Begin by contacting NCTracks at 800-688-6696. Staff can escalate issues to an internal SWAT team focused on problem identification and resolution. When needed, issues can be escalated to our SWAT team by calling (919) 527-7460 or emailing MedicaidSWAT@dhhs.nc.gov.
Learn more. The Department will host a webinar to update all Medicaid providers who want beneficiaries assigned to them as a PCP during auto-enrollment.
PROVIDER WEBINAR
Sept. 24, 2019
2-2:30 p.m.
Registration required