NC Medicaid Managed Care Provider Update – Nov. 29, 2022

Upcoming milestones, Provider Playbook updates, organizational Provider affiliation requirement, Beneficiary assignment file and more

Upcoming Key Milestones for NC Medicaid Managed Care

Post Oct. 14, 2022

Tailored Care Management Provider Auto-Assignment (by NC Medicaid) for beneficiaries who have not chosen a Tailored Care Management provider

Nov. 7, 2022

LME/MCOs begin mailing Tailored Care Management assignments to beneficiaries

Dec. 1, 2022

Tailored Care Management goes live

March 2, 2023

Tailored Plan Pharmacy, Nurse and Behavioral Health Crisis lines go live

April 1, 2023

Implementation of Tailored Plans delayed until April 1, 2023

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.

  • What Providers Need to know Before Tailored Plan Launch – Sept. 9, 2022
  • Panel Management – Sept. 14, 2022
  • Overview of Provider Directory Data Flow – Sept. 27, 2022
  • Nursing Facility – PHP Process – Oct. 17, 2022
  • Nursing Facility Placement – Oct. 17, 2022
  • Medicaid and NC Health Choice Provider and Health Plan Lookup Tool – Oct. 28, 2022
  • NC Medicaid Managed Care: Provider Training – Nov. 28, 2022

Organizational Provider Affiliation Requirement

Currently enrolled organizations with no affiliated individual providers will receive notices which include a deadline to affiliate at least one active individual provider according to specified criteria. Newly enrolling organizations have 90 days to meet this requirement.  

Recently, NC Medicaid modified this requirement to accept individual provider affiliations from a Behavioral Health and Social Service Level 1 Taxonomy provider type for organizations with an active Single Specialty or Multi-specialty taxonomy.  

For additional information, see the related bulletin article Organizational Provider Records Without the Required Individual Provider Affiliation Risk Suspension/Termination.

Beneficiary Assignment File

The Beneficiary Assignment File will be shared by the LME-MCOs with Tailored Care Management providers on Nov. 20, 2022. This file includes demographic data and any clinically relevant and available eligibility info for members assigned to a provider for Tailored Care Management. Providers can review the Data Specifications for the file on the Tailored Care Management web page

Provider Reverification

Provider Reverification will resume at the end of the federal Public Health Emergency (PHE). Notices will be sent to providers with approaching reverification due dates, as well as those for whom reverification was suspended during the federal PHE. For more information, see Provider Reverification Requirements to be Reinstated.

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.

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

Responses to inquiries are autogenerated from ServiceNow and sent directly to the inquirers email address. The subject line will read “NC Medicaid Inquiry COM00XXXXX Has Been Closed” and be sent from: IT Service Desk <Medicaid.HelpCenter@dhhs.nc.gov>

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.

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.

The latest schedule, registration and information on previous webinars, including the recording, slides, and transcript are available on the AHEC Medicaid Managed Care webpage

Contact

NCTracks Call Center: 800-688-6696

Provider Ombudsman: 866-304-7062

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