NC Medicaid Managed Care Provider Update – Feb. 3, 2022

Upcoming Key Milestones 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.

• Managed Care Eligibility for Newborns: What Providers Need to Know – Jan 9, 2023
• What Providers Need to Know Before Tailored Plan Launch – Jan 6, 2023
• Tailored Plan Provider Contracting Deadlines Q&A – Dec 19, 2022
• Protections for Pregnant Women and Newborns – Dec 19, 2022
• Contracting with Tailored Plans – Dec 15, 2022
• Tailored Care Management – Dec 1, 2022

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.

Some providers are receiving notification of a voluntary reverification program underway through March 2023. This is a time-limited opportunity that allows providers to get ahead of the reverification rush and is applicable to only those providers who were due for reverification during the federal PHE. No adverse action will occur if the provider does not submit the voluntary reverification application. For more information, see the Voluntary Reverification bulletin article.

Interim Report to Assist Providers in Verifying Their Records

The Department continues to offer Provider Directory Listing and Affiliation Reports for Standard Plans and Tailored Plans in the Provider Playbook. Providers may filter this report to review information about multiple records simultaneously. If erroneous information if found and updates needed, the appropriate Office Administrator must submit an NCTracks Manage Change Request (MCR). A Field Description tab is available on the report to connect the section of the MCR to the field in the report displaying the information. For additional information, see Ensure Your Information Displays Correctly in NC’s Provider Directory Tool – Provider & Health Plan Look-Up.

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