AMH NC Medicaid Direct/Managed Care PCP Enrollee Report – How to Read & Use Your Enrollee Report
To assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program, NCDHHS generated a new Advanced Medical Home (AMH) NC Medicaid Direct/NC Medicaid Managed Care Primary Care Provider (PCP) Enrollee Report for distribution to CCNC/CA participating providers.
The report, initially made available on March 15, 2021, is delivered each month to the NCTracks Secure Provider Portal Message Inbox the Monday before the second checkwrite to coincide with the receipt of CCNC/CA management fees.
The AMH Medicaid Direct/Managed Care PCP Enrollee Report contains a list of all NC Medicaid beneficiaries who have been assigned to the identified NPI in the past 12 months and contains:
- NPI/Atypical ID
- Provider name
- Service location address (to which the beneficiary is assigned)
- Medicaid Identification Number
- Recipient name
- Date of birth
- Active (Y or N) (currently enrolled in Medicaid and assigned to you)
- Assignment program (i.e. Med-Dir for NC Medicaid Direct)
- Effective date (of assignment)
- End date (of assignment)
- Last office visit (based on paid claims from the billing NPI)
- Total visits (based on paid claims for the past 12 months)
To effectively use the report, add filters or sort the report based on an Active status of “Y.” In this way, the provider can narrow the results to display only those currently enrolled in NC Medicaid and assigned to the identified NPI.
In addition to the Active status, the End Date of assignment will display the current eligibility span for the beneficiary which includes the provider assignment.
It is imperative to understand that this is not verification of eligibility or PCP assignment through that End Date.
NC Medicaid beneficiary benefits or PCP assignment may terminate at the end of any given month. Providers must verify eligibility through the NCTracks Recipient Eligibility Verification function each month to ensure coverage and inform the beneficiary of any changing prior to rendering services.
The most unique feature of the AMH Medicaid Direct/Managed Care PCP Enrollee Report is the identification of the most recent office visit and total number of office visits paid to the identified NPI. This information is offered on the report so providers may confirm whether an active relationship exists with the beneficiary. The dates and number of visits is based on paid claims when the identified NPI in the report is used as the Billing NPI on a paid claim within the past 12 months.
Primary Care Providers (PCPs) actively caring for beneficiaries not showing as assigned to their practice may help update their practice assignment by encouraging beneficiaries to contact their local Department of Social Services (DSS) caseworker to request reassignment. As an alternative, provider staff may complete the Community Care of North Carolina/Carolina ACCESS Enrollment Form for Medicaid Recipient, ask the beneficiary to confirm the change with their signature on the form and fax the form to the local DSS office. Fax numbers and other contact information are available on the Local DSS Directory.
Only the beneficiary may request PCP reassignment. In instances where issues persist or escalation is needed, providers may encourage beneficiaries to contact the Medicaid Contact Center at 888-245-0179 for assistance.
Based on feedback from providers regarding the AMH Medicaid Direct/Managed Care PCP Enrollee Report, and to better assist providers, NC Medicaid is in process of updating functionality to include health plan members and the name of the health plan to which each is assigned. Although the timeline for the addition is yet to be determined, the report will display the health plan name beginning in July 2021 when managed care assignments become effective.
NCTracks Call Center: 800-688-6696