Provider Reverification
Providers for whom recredentialing/reverification was delayed are being notified of their requirement to complete the reverification process. Notifications are sent to the NCTracks Message Center Inbox on the secure Provider Portal. Failure to respond will result in suspension and subsequent termination of the provider record.
A list of providers due for reverification through December 2023 is available on the Provider Enrollment Recredentialing webpage. The reverification due date is the suspension date if no action is taken. Please respond to notifications in a timely manner to maintain participation with NC Medicaid programs.
For additional information, please visit the Provider Recredentialing/Reverification page on the NCTracks Provider Portal.
Tailored Plan Implementation Delayed
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans) scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined.
Beneficiaries who will be covered by the Tailored Plans will continue to receive behavioral health, I/DD, TBI and physical health care as they do today.
For more information, please see recently published Medicaid bulletin article, Tailored Plan Implementation Delayed.
Providers are encouraged to stay informed on the implementation of Tailored Plans through fact sheets and other resources available in the Medicaid Managed Care Provider Playbook. The following Tailored Plan fact sheets have been updated and are available under the Medicaid Transformation option:
- Tailored Care Management
- Tailored Plan Enrollment and Timeline
- What Providers Need to Know Before Tailored Plan Launch
- What Providers Need to Know After Tailored Plan Launch
NC Healthy Opportunities Pilots Reflect on First Year of Services
In honor of the one-year anniversary of the first Healthy Opportunities Pilot (HOP) Program services launch in March 2022, the Healthy Opportunities Pilots Continuous Improvement Efforts Year 1 Update Fact Sheet and Healthy Opportunities Pilots Rapid Cycle Assessment 1 Summary were recently posted to the NCDHHS Healthy Opportunities webpage.
For highlights from the first year and how to refer Medicaid Members for services, see bulletin article More than 8,500 Medicaid Members Receive Healthy Opportunities Services in First Year.
For up-to-date metrics, and stories from the community please visit Healthy Opportunities Pilots at Work webpage.
Keep NCTracks Provider Records Current
Medicaid Managed Care health plans, as well as the NC Medicaid Provider and Health Plan Lookup Tool must use information from the NCTracks provider record for their directories. For this reason, and because NC Medicaid recently announced a Provider Data Management/Credentialing Verification Organization Solution Coming in 2024, it is essential for providers to ensure all data in each active NCTracks provider record is accurate.
To assist with this effort and allow for the organization and basic review of multiple records concurrently, the Department continues to offer Provider Directory Listing and Affiliation Reports for Standard Plans and Tailored Plans in the Provider Playbook under Trending Topics. These reports are updated regularly and serve as a resource for verifying the contract status with health plans.
The ongoing accuracy of provider enrollment information is not only contractually required of providers, but also vital to the successful sharing of data among health plans and the incorporation into new solutions. For additional information, see the related bulletin article 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 the 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 will be sent from this email address: 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 NC Medicaid Managed Care, COVID-19, Medicaid and behavioral health services, and is used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this tool:
- Go to the NC Medicaid Help Center
- Type a topic or key words into the search bar
- 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
The latest schedule, registration and information on previous webinars, including recordings, slides and transcripts are available on the AHEC Medicaid Managed Care website.
Contact
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062