NC Medicaid Managed Care Provider Update – Feb. 23, 2022

Upcoming Key Milestone Dates for NC Medicaid Managed Care

Provider Playbook Updates

The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. The latest resources are added to the fact sheet page.

COVID-19 Vaccine Incentive Program

A fact sheet covering the Vaccine Incentive Program has been posted to the NC Medicaid COVID-19 Guidance and Resources Page. The fact sheet provides a summary of each Standard Plan COVID-19 Member Incentive Program and links to more detailed information on the Standard Plan member incentives. 

Provider Prior Authorizations

If a provider needs to verify the status of a PA request, please contact the health plan provider relations team directly at:

• AmeriHealth Caritas: Provider Services: 888-738-0004 
• Carolina Complete: Provider Services: 833-552-3876 
• Healthy Blue: Provider Services: 844-594-5072 
• United Healthcare: Provider Services: 800-638-3302 
• WellCare: Provider Services: 866-799-5318 

For more information about PAs, see the Managed Care Claims and Prior Authorization Submission fact sheets under Programs and Services.

Provider Ombudsman

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.

The Provider Ombudsman service is separate from the Health Plans’ Provider Grievances and Appeals process and should be used as an escalation after contacting Health Plans and searching the NC Medicaid Help Center (see below). 

Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or by calling the NC Medicaid Managed Care Provider Ombudsman at 866-304-7062. 

Help Center 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:

1. Go to NC Medicaid Help Center
2. Type a topic or key words into the search bar
3. Select a topic from the available list of  categories

Detailed information about the NC Medicaid Help Center is available in a Medicaid Bulletin updated on June 17, 2021.

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

Reports are 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 on the “Medicaid and NC Health Choice Provider and Health Plan Look-up Tool.”

For assistance with completing an NCTracks Manage Change Request, providers should reference the NCTracks Provider User Guides and Training tools located at: https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html

PHP Quick Reference Guides

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 to the Provider Playbook Training Courses webpage.

The Provider Ombudsman service is separate from the Health Plans’ Provider Grievances and Appeals process and should be used as an escalation after contacting Health Plans and searching the NC Medicaid Help Center. 

Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or by calling the NC Medicaid Managed Care Provider Ombudsman at 866-304-7062. 

Upcoming NC Medicaid Managed Care Webinars

Medicaid Managed Care: Quality & Population Health Webinar
Thursday, Feb. 24, 2022 | 5:30-6:30 p.m. Register

This series, formerly the Advanced Medical Home (AMH) Webinar Series, is designed to support practice managers, quality improvement professionals, care coordinators, and others within your practice who are responsible for meeting the NC Medicaid Managed Care provider requirements. Join us on Thursday, Feb. 24 from 5:30-6:30 p.m. for a discussion on Evaluating Medicaid Transformation.

The Research Evidence on the Efficacy of Telehealth for Addiction and Mental Health
March 3, 2022 | 1–2 p.m. 

• Can telehealth improve access to care?
• What is the efficacy of telehealth for mental health and addiction treatment?
• How can data inform evolving policies regarding telehealth?

Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars, as well as recordings, slides and transcripts from previous webinars.

Contact

NCTracks Call Center: 800-688-6696