Please note this bulletin was updated on June 17, 2021, to add the new phone number for the Provider Ombudsman.
Key Dates for Transitioning to Medicaid Managed Care
- March 15, 2021 – Open Enrollment started
- 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
Although the contracting milestones previously identified by the NC Department of Health and Human Services (DHHS) have passed, that should not deter uncontracted providers from quickly beginning that process to best ensure participation in a health plan’s network at managed care launch (July 1, 2021).
In order for a provider to be included in a health plan’s network at managed care launch, contracts should be executed with health plans as early as possible. Health plans need sufficient time for signed contracts to be returned and to process those contracts. Typically, health plan processing time is two to three weeks, but may take longer. Providers need to contract with health plans in a timely fashion to avoid losing patients or otherwise disrupting the provider’s Medicaid business.
Provider Playbook Updates
DHHS re-launched the online Provider Playbook as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to NC Medicaid Managed Care. The Provider Playbook is a collection of information and tools specifically tailored to providers. New resources to the Fact Sheet page include:
- Provider Payment – An overview of the requirements providers and health plans must follow regarding pharmacy claims, payment by electronic fund transfers and appeals to ensure payments are made in a reasonable time frame.
- What Providers need to know after Managed Care Launch – An overview of key dates, reminders and links to assist providers and their beneficiaries after Managed Care launch on July 1, 2021.
- Health Equity Enhanced Payment Initiative – An overview of the Enhanced Payment Initiative NC Medicaid is introducing to Carolina Access primary care practices serving beneficiaries from parts of the state with high poverty rates. Payments will be available for three months as a limited initiative from April-June 2021.
- Telehealth Program (Updated) – An overview of the different virtual health care services available across the state under the Telehealth Program. Telehealth allows patients to stay safely at home while still receiving the care that they need.
- Combined PHP Quick Reference Guide – A quick reference guide (QRG) designed for providers to use on day one of NC Medicaid Managed Care go-live. This QRG gives providers access to the information they will most frequently use such as contact numbers, email addresses, prior authorizations and claims information for each of the health plans.
New resources will be added to the Provider Playbook as they become available.
Provider Outreach to Patient Panels
Some providers are encouraging patients to sign up for managed care and listing the health plans they have contracted with to help patients with health plan selection. We welcome this engagement from our providers, but please note that not all Medicaid beneficiaries are moving to managed care. Receiving letters or other information from providers to sign up for a health plan is causing some confusion for beneficiaries who are not required to sign up at this time.
If your practice is conducting outreach, we encourage providers to include the following language in any communication to patients about your contracted health plans and signing up for NC Medicaid Managed Care:
This letter is not an official enrollment notice. Depending on your current eligibility, you may not be required to enroll with a health plan. Please call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588) for assistance.
Webinar Series for Medicaid Providers and Practice Leaders
NC Medicaid Managed Care Hot Topics Webinar Series on the first and third Thursday of the Month
The Medicaid webinars on the first and third Thursday of the month are dedicated to bringing you late breaking information/guidance on NC Medicaid’s transition to Managed Care. Topics will vary, but each session will include an open question and answer period.
Upcoming topics will include: pharmacy and durable medical equipment, behavioral health, transitions of care, specialized therapies, quality measures, network adequacy, provider directory, billing, incentive payments, clinical coverage policy updates, and more. To register to attend visit the AHEC Medicaid Managed Care webpage.
Upcoming Webinars
Thursday, May 6, 2021 | Behavioral Health
Thursday, May 20, 2021 | Specialized Therapies
Thursday, June 3, 2021 | Transitions of Care
Advanced Medical Home Webinar Series
Thursday, May 13, 2021 | Promising Practices (Case Studies, Stories from the field)
The latest schedule, registration and information about previous webinars is available here.
Virtual Office Hours
NC Medicaid and NC AHEC are conducting a series of virtual office hours for providers which began in March 2021. These sessions offer an interactive format for providers to have their questions answered.
Providers are encouraged to submit questions in advance. Virtual Office Hours will cover a range of NC Medicaid Managed Care topics. For the most up-to-date schedule, visit the AHEC Medicaid Managed Care webpage.
Health Plan Virtual Meet and Greet Sessions
NC Medicaid and NC AHEC are hosting virtual health plan meet and greet sessions, which began on March 24, 2021. NC Medicaid consultants and health plan representatives are available to address your concerns and questions about the transition from Medicaid fee-for-service to NC Medicaid Managed Care.
Virtual meet and greet sessions are structured as conversations between providers and health plan staff with a question and answer session for participants. Sessions will be delivered live with a recording and transcript made available after each event. For the most up-to-date schedule and to register, visit the AHEC Medicaid Managed Care webpage.
Ensure Your Information Displays Correctly in NC’s Provider Directory – Medicaid and NC Health Choice Provider and Health Plan Look-Up Tool
Starting on April 13, 2021, interim reports are temporarily available on the Managed Care Provider Playbook Resources page to assist providers in verifying their records. The Provider Directory Listing Report, as well as the Provider Affiliation Report, is available to all actively enrolled Medicaid and NC Health Choice providers. In combination, these reports allow all providers to confirm the information visible to NC Medicaid beneficiaries as each utilize the “Medicaid and NC Health Choice Provider and Health Plan Look-up Tool” to find participating provider information, and if applicable, enroll in NC Medicaid Managed Care.
- Providers may use the NCTracks MCR process, available in the Secure NCTracks Provider Portal, to modify any provider record or service location information as well as individual to organization affiliations.
- If the Provider Affiliation information is incorrect, the affiliated individual provider or the Office Administrator for the affiliated individual provider must update the group affiliation.
- Providers unable to find their practice associated with the correct health plans should reach out directly to the health plan to discuss contracting options. If contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve.
As NC Medicaid moves forward with the implementation of NC Medicaid Managed Care, it is important enrolled providers use these resources to thoroughly review their individual and organization provider enrollment information and submit changes as needed using the Manage Change Request process.
More information is available here.
PHP Quick Reference Guides Created
NC Medicaid’s Managed Care Prepaid Health Plans (PHPs) created quick reference guides to include the most current and comprehensive information for providers.
The PHP quick reference guides are available on the Provider Playbook Fact Sheet webpage under the Health Plan Resources section. Links to the Health Plan training webpages have also been added on the Provider Playbook Training Courses webpage.
Help Center Now Available for Providers to Find Information
The NC Medicaid Help Center is an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this new tool:
- Go to NC Medicaid Help Center
- Type a topic or key words into the search bar
- Select a topic from the available list of Categories
More information about the NC Medicaid Help Center is available here.
Provider Ombudsman
NC Medicaid offers a Provider Ombudsman to assist providers transitioning to NC Medicaid Managed Care by receiving and responding to inquiries, concerns and complaints regarding health plans. This service is intended to represent the interests of the provider community, provide supportive resources and assist with issues through resolution.
The Ombudsman will also investigate and address complaints of alleged maladministration or violations of rights against the health plans. Health plans are expected to resolve complaints promptly and furnish a summary of final resolution to NC Medicaid. Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or the Medicaid Managed Care Provider Ombudsman at 866-304-7062. Likewise, responses may also be delivered through either email or by phone. The Provider Ombudsman contact information can be found in each health plan’s Provider Manual linked on the Health Plan Contacts and Resources Page.
Additionally, the Ombudsman will assist providers with Health Information Exchange (HIE) inquiries related to NC HealthConnex connectivity compliance and the HIE Hardship Extension process.
The Ombudsman service is separate and apart from the Health Plans Provider Grievances and Appeals process. Each health plan has a grievance and appeal process for providers, separate from the process for beneficiaries, which can be found in each health plan’s Provider Manual, linked on the Health Plan Contacts and Resources Page.
Tailored Care Management Certification
To continue supporting providers interested in obtaining certification as an Advanced Medical Home Plus (AMH+) practice or Care Management Agency (CMA), the Department extended the Round 1 application deadline from March 1, 2021 to June 1, 2021. More information is available here.