LME/MCO consolidation
LME/MCO consolidation, dissolving Sandhills Center and consolidating Eastpointe and Trillium Health Resources, is effective Feb. 1, 2024. The Department posted an LME/MCO Consolidation Overview and FAQs – For Providers that offers additional detail on consolidation components, impacts to beneficiaries and guidance to providers.
Appendix K Flexibilities Approved for Innovations and Traumatic Brain Injury Waivers
On Nov. 22, 2023, the Centers for Medicare, and Medicaid Services (CMS) approved North Carolina Medicaid to continue certain Appendix K flexibilities in the 1915 (c) Innovations Waiver and TBI (Traumatic Brain Injury) Waiver amendment, effective March 1, 2024.
Federal Fee Increase for Provider Enrollment
Effective Jan. 1, 2024, the federal fee for Medicaid provider enrollment increased to $709, and will be required as noted on the Provider Permission Matrix for initial enrollment, re-enrollment, and reverification applications, as well as manage change requests (MCR) to add a new site location.
Additional information regarding the federal fee can be found at Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2024.
New Exclusion Sanction Questions to be added to Applications for Provider Enrollment
Beginning Jan. 28, 2024, five additional exclusion sanction questions will be added to provider enrollment, re-enrollment, full managed change requests (MCRs), office administrator (OA), and re-verification applications.
Additional information about the new exclusion sanction questions can be found on the NCTracks Provider Announcement.
Provider Reverification
- As of Dec 31, 2023, a total of 14,824 reverification applications have been submitted of 24,272 initial provider notifications sent, representing a 61% response rate. There have been 8,269 cumulative provider suspensions due to failure to submit a reverification application and 3,649 subsequent terminations. Overall, 15% of providers notified of the requirement to reverify have ultimately terminated. As a reminder, reverification is required upon notification from NCTracks.
- As you complete your reverification (or any) application, be sure to review your entire provider record thoroughly prior to submission. To update active owner/managing employee information (i.e. name, date of birth, social security number), end-date the existing relationship and re-enter with the new or correct information. If other changes are needed in a field that you cannot edit in the application, please contact the NCTracks Provider Call Center for guidance before submitting the application to confirm next steps.
- Many resources are available to assist with the reverification process: Bulletin Articles: Search for keyword “reverification” and also review Provider Reverifications Reminders.
- Provider Reverification/Recredentialing Webpage – Also contains link to the reverification due date list referenced above.
- Reverification/Recredentialing FAQs
- User Guide: “How to Complete Re-verification in NCTracks”
- NCTracks Provider Call Center: 800-688-6696
- NC Medicaid Provider Ombudsman: Medicaid.ProviderOmbudsman@dhhs.nc.gov
License Accreditation Certification
An NCTracks automated process scans each record for an expiring credential (license, accreditation, certification) and initiates letters to providers 60 days prior to expiration. If no action is taken to update the credential, the associated taxonomy code(s) will be suspended. A suspension letter is generated and sent to the Message Center Inbox with the subject Recertify Suspension Letter. The suspension will remain in place for another 60 calendar days unless the credential is renewed, which will lift the suspension. Note: Suspension means your claims will pend and will not pay until the suspension is lifted. See NCTracks License and Accreditation FAQs for additional information.
Medicaid Expansion Launched Dec. 1, 2023
Medicaid Expansion launched on Dec. 1, 2023, giving more than 600,000 North Carolinians access to health care. A new Fact Sheet is available in the NC Medicaid Managed Care Provider Playbook to inform providers of the process for enrollment, as well as the identification and verification of benefits for newly enrolled members. On the Fact Sheet webpage, under Programs and Services, see “What Providers need to know about Medicaid Expansion.” Also, for more information, please see the Medicaid Expansion webpage or the Questions and Answers about Medicaid Expansion webpage.
NC Medicaid Managed Care Information and Resources
Providers are encouraged to remain informed of NC Medicaid Managed Care Transformation through the following resources:
- Medicaid Managed Care Provider Playbook. Trending Data: Interim Reports to assist providers with verifying their record and PHP contracted information continue to be updated
- Health Plans webpage – Contact information for all health plans, as well as health plan contract requirements and information.
- Financial and Statistical Reports – Contains a variety of dashboards and reports related NC Medicaid activities.
Provider Ombudsman
The health plan grievance and appeal process for providers 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’ process and should be used only as an escalation after contacting health plans and seeking guidance through 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 may be autogenerated from ServiceNow to the inquirer’s email or received from a Provider Ombudsman team member interested in helping to resolve your inquiry. When your inquiry is considered resolved and closed, a final email with subject line “NC Medicaid Inquiry COM00XXXXX Has Been Closed” will be sent from Medicaid.HelpCenter@dhhs.nc.gov.
NC Medicaid Webinars
Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars and virtual office hour sessions. Webinars inform providers of all happenings within NC Medicaid, making attendance vital to staying informed. Recordings, slides, and transcripts from previous webinars are available.
- Virtual Office Hours for Providers: March 7, 2024, at 5:30 p.m. | Provider Enrollment
Contacts
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062