Medicaid Managed Care Provider Update

Tuesday, December 8, 2020

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

In order to be included in the Medicaid and NC Health Choice Provider and Health Plan Look-up Tool and PHP provider directories used by beneficiaries during open enrollment (March 15, 2021), providers must submit signed contracts to PHPs by Feb. 1, 2021. In order for a provider’s information to be used in auto-enrollment (May 15, 2021), contracts must be submitted to PHPs by April 12, 2021. 

This allows sufficient time for signed contracts to be returned and for the PHP to process those contracts. Typically, PHP processing time is two to three weeks, but may take longer. Primary Care 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.

Webinar Series for Medicaid Providers and Practice Leaders

The North Carolina Department of Health and Human Services (NCDHHS) and North Carolina Area Health Education Centers (AHEC) have partnered to host a series of webinars on the first and third Thursdays of each month to increase engagement with providers, practice managers, and quality managers. The series on the first Thursday of the month is specifically focused on the transition to Medicaid Managed Care, and the series on the third Thursday of the month is focused on Quality and Performance on clinical criteria. More information is available here.

Ensure Your Information Displays Correctly in NC’s Provider Directory – Medicaid and NC Health Choice Provider and Health Plan Look-Up Tool

As NC Medicaid moves forward with the implementation of Medicaid Managed Care, it is important for enrolled providers to act now to thoroughly review their individual and organization provider enrollment record in NCTracks. Take the time now to review your provider records in NCTracks and submit changes as needed using the Manage Change Request process.

Not only is ensuring accuracy a requirement in the legal and binding NCDHHS Provider Administrative Participation Agreement, but correct information on the NCTracks provider record will assist beneficiaries with the search for primary care providers in the new Medicaid and NC Health Choice Provider and Health Plan Look-Up tool, expected to be available Jan. 25, 2021. Every page of the NCTracks provider record should be assessed for accuracy. More information is available here.

Provider Ombudsman

The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.

Additionally, the Ombudsman will assist providers with Health Information Exchange (HIE) inquires related to NC HealthConnex connectivity compliance and the HIE Hardship Extension process.

Provider Ombudsman inquiries, concerns or complaints can be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov, or providers may utilize the  Provider Ombudsman line at 919-527-6666. The Provider Ombudsman contact information will also be published in each PHP provider manual.

PHP Provider Manuals Updated

NC Medicaid’s Managed Care PHPs have finalized and the Department has approved all five PHP provider manuals to include the most current and comprehensive information for providers. 

PHPs are contractually obligated to maintain the content of their PHP Provider Manual to offer providers the tools and resources necessary for the delivery of quality care and services to Medicaid and NC Health Choice beneficiaries. Likewise, providers must use the manual for each contracted PHP as a means of remaining current on PHP policies which will reflect any changes in state and federal regulations. 

The Department-approved PHP provider manuals are available on the Medicaid Health Plan Contacts and Resources webpage

Going forward, each new PHP provider manual update will illustrate what has changed from the previous version. Manuals will be updated annually on July 1 and quarterly as needed for time sensitive changes.

NC Medicaid Expands Website to Include New Resources to Support Medicaid Beneficiaries

NCDHHS has launched a new Beneficiary Portal on the NC Medicaid website. The portal will serve as a centralized information resource center for current Medicaid beneficiaries and those wishing to apply for Medicaid benefits. It also offers information about Medicaid Managed Care, set to launch July 1, 2021. More information is available here.

Stay tuned to the Medicaid Bulletin for additional updates on Medicaid Managed Care. 

Contact

NC Medicaid Contact Center, 888-245-0179