Provider and Health Plan Contract Deadlines for Inclusion in Open Enrollment and Auto-Enrollment

Thursday, November 19, 2020

For inclusion in open enrollment and auto-enrollment, provider contracts must be signed and mailed to health plan by:

  • Feb. 1, 2021, for inclusion in open enrollment, and
  • April 12, 2021, for inclusion in auto-enrollment.

During open enrollment (March 15, 2021 through May 14, 2021) for Medicaid Managed Care, beneficiaries will choose a health plan and primary care provider (PCP). Those beneficiaries who do not make a choice will be auto-enrolled (commences on May 15, 2021 and runs for six days) in a health plan.

These recommended provider contracting deadlines allow health plans to process provider contracts and ensure that provider records are loaded correctly and transmitted to our Enrollment Broker. 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 open enrollment and auto-enrollment processes.

PCPs who do not contract with health plans by the deadlines risk losing patients, as beneficiaries will choose a PCP from the chosen health plan’s in-network providers, and health plans will auto-assign beneficiaries only with network providers. If a contract is not in place by July 1, 2021, and the provider has not engaged in good faith negotiations, the provider is at risk for being reimbursed at 90% of the current Medicaid fee for service rate and subject to additional prior authorizations.

Medicaid has traditionally experienced high provider enrollment rates, which we want to continue. 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 Health Plan Contacts and Resources web page.

Questions and answers relating to provider contracting deadlines are available on the Provider Contracting with Health Plans webpage.

As NC Medicaid moves toward Managed Care Launch, please keep sharing what is working and what is not. Begin by contacting NCTracks at 800-688-6696. Questions or comments may also be submitted at Medicaid.transformation@dhhs.nc.gov.