On June 15, 2023, the North Carolina Department of Health and Human Services announced Keystone Peer Review Organization, Inc. (Kepro), also known as Acentra Health, was awarded the contract as NC Medicaid’s Comprehensive Independent Assessment Entity (CIAE).
As a result, Acentra Health assumed the management and oversight of the Preadmission Screening Resident Review (PASRR) Level II process from EarthMark Consultants (a subcontractor for Gainwell Technologies) on Aug. 9, 2023. Since the transition, Acentra has experienced delays in scheduling and completing Level II evaluations.
NC Medicaid implemented a process to mitigate any adverse impact for nursing facilities (NFs) prior authorizations (PAs) if a PASRR authorization is delayed. Effective Aug. 10, 2023, GDIT has been instructed to retroactively approve a PA request when the NF LOC criteria has been met and there is a gap in a PASRR authorization due to a processing delay on the part of Acentra.
- The retroactive PA process will only be used in situations where there is a gap in PASRR authorizations due to a processing delay by Acentra.
- Please note a PASRR authorization cannot be retroactively authorized.
Providers should continue to submit new and significant change PASRR authorization requests via NCMUST within the required timeframe noted in Clinical Coverage Policy 2B-1.
For questions regarding the PASRR Level II evaluation process or information about the status of a Level II referral, contact Acentra at 833-522-5429.
Providers may also contact the Provider Ombudsman at 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov if their concern was not adequately addressed by Acentra.
Contact
NC Medicaid Contact Center: 888-245-0179