Medicaid Bulletin

As a reminder, NC Medicaid is taking additional steps to ensure providers meet their contractual obligation to keep credentials current on their NCTracks enrollment effective May 9, 2021. NCTracks will generate a notification to providers at 60, 30 and 14 calendar days prior to the expiration date of the credential; and will begin a process of suspension if a provider fails to update their credential.

To assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program, NCDHHS generated a new Advanced Medical Home (AMH) NC Medicaid Direct/NC Medicaid Managed Care Primary Care Provider (PCP) Enrollee Report for distribution to CCNC/CA participating providers.

Effective May 9, 2021, NC Medicaid is taking additional steps to ensure providers meet their contractual obligation to keep credentials current on their NCTracks enrollment.

Key dates for transitioning to NC Medicaid Managed Care, Provider contracting reminders, Provider Playbook updates, Provider outreach to patient panels, webinars, Provider and health plan look-up tool, PHP quick reference guides, help center, Provider Ombudsman and Tailored Care Management certification.

Providers with Denials for Healthy Opportunities Screening, Assessment and Referrals Claims due to edit 02088 may now resubmit claims; Place of Service Indicator codes updated.

NC Medicaid will offer time-limited payments to practices that have attested as an Advanced Medical Home Tier 3 if they can demonstrate successful readiness for AMH Tier 3 responsibilities.

Changes have been made to the Clinical Pharmacy Practitioners (CPPs) fee schedule to more accurately reflect the types of services provided by a CPP certified by the NC Board of Pharmacy.

The Department is releasing the draft Tailored Care Management Desk Review Guide and Scoring Tool to support providers applying for AMH+ or Care Management Agency certification. 

To ensure NC Medicaid continues to move forward with EVV implementation and can fully integrate EVV through claims adjudication for all providers, alternate EVV solutions must pass testing validation by April 30, 2021.

This bulletin provides an update on the final reconciliation activity related to nursing facility staff COVID-19 testing payments authorized under Secretarial Orders No. 2 and No. 4.