NC Medicaid Managed Care Provider Update – March 18, 2022

Key dates, playbook updates, coverage for pregnant beneficiaries extended to 12 months and more

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.

NC Medicaid Coverage for Pregnant Beneficiaries Extended to 12 Months

Effective April 1, 2022, NC Medicaid coverage for pregnant beneficiaries will extend to the last day of the month in which the 12-month postpartum period ends. The change is made pursuant to NC Senate Bill 105 Session Law 2021-180 Section 9D.13 and the American Rescue Plan Act of 2021. These laws are in effect through March 31, 2027.

Detailed information about the 12-month postpartum extension is available in a Feb. 22, 2022, Medicaid bulletin.

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

Provider Reverification

As the federal Public Health Emergency (PHE) comes to an end, so does the suspension of reverification for providers enrolled in NC Medicaid. Beginning Summer of 2022, providers will begin receiving reverification notices again. These notices will be sent to providers with approaching reverification due dates, as well as those whose reverification was suspended during the PHE. For more information see Provider Reverification Requirements to be Reinstated.

Taxonomy Reminders

Health plans have identified a trend in claims denials related to the taxonomy used on the claim as well as suspended providers. Providers are reminded:

1. The taxonomy submitted on a claim for billing, rendering and attending providers must be a taxonomy for which the provider is enrolled with NC Medicaid.  
2. Licensing information must remain current to avoid suspension and termination of the taxonomy. Providers receive multiple notifications for expiring credentials and are encouraged to respond quickly to ensure their license is renewed as appropriate and updated on their NC Medicaid provider record.  

Additional information is available in the Taxonomy Enrollment Requirement Reminders for Claim Payment, and the NCTracks Changes to Provider Verification Process bulletins.

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.

Upcoming NC Medicaid Managed Care Webinars

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