Donate to Hurricane Recovery

Resources

Please note: The Provider Playbook, policy papers, fact sheets, and other documents and information include content that was effective when published and may not reflect changes in timing, schedules and other details due to the suspension of Managed Care.

Health Plan Networks: Enrollment and Assignment of Beneficiaries to Health Plans and PCP Practices

Auto-assignment has been suspended. However, providers should continue to contract with health plans. The information below describes enrollment and assignment of beneficiaries, and is planned when Medicaid Managed Care is no longer suspended. Providers can continue to verify if their practice is listed with the correct health plans.

How Health Plan Auto-Enrollment will be Affected by Beneficiary-PCP Relationships

Beneficiaries will be automatically enrolled in a health plan if they do not choose one during open enrollment. Beneficiaries will be enrolled first in the health plan with their PCP/AMH’s practice in its network, followed by other criteria set by the Department. Note that automatic health plan enrollment in most cases identifies a health care practice, not an individual provider. Providers must complete contracting with a health plan and appear in its provider directory to be recognized for automatic health plan enrollment and PCP/AMH assignment.

How PCP Auto-Assignment is Affected by Beneficiary-PCP Relationships

Health plans will assign beneficiaries to a network PCP/AMH if one was not chosen during open enrollment. PCPs are first assigned based on prior relationships with the beneficiaries, followed by other criteria set by the Department. 

How to Verify That Your Practice is an Option for PHP Enrollment and PCP Assignment

Once you have completed contracting with a health plan, verify your information is in the health plan’s provider directory. Click here for a report listing providers and the health plans they have contracted with. Links to the health plan provider directories can be found below. This report will be updated in January. 

If your practice is not with the correct health plans, please call the health plan’s provider support team. 

AmeriHealth Caritas   1-888-738-0004
Healthy Blue         1-844-594-5072
Carolina Complete Health  1-833-552-3876
UnitedHealthcare 1-800-638-3302
WellCare 1-866-799-5318   

                               

Practice Support and Technical Assistance

NC Medicaid, in partnership with NC Area Health Education Centers (AHEC), will be providing education and engagement, outreach and practice-level technical assistance to essential practices on transition processes and quality initiatives as NC Medicaid transitions to managed care. This high-level interaction is intended to help Medicaid providers successfully transition to managed care.

The partnership is assisting with webinars, online resources, meet-and-greet events with health plans across the state, virtual office hours and regional-focused training events. More information and resources are available in the Provider Playbook for Medicaid Transformation at: https://medicaid.ncdhhs.gov/providers/provider-playbook-medicaid-managed-care.
 
This support will also focus on rural and independent practices, including on-site coaching and technical assistance. For more information, please visit:  https://www.ncahec.net/practice-support/what-we-do. For questions, email Practicesupport@ncahec.net.

Events

Health Plan Meet and Greet Sessions

With managed care suspended, NC Medicaid will be rescheduling the Health Plan Meet and Greet sessions scheduled for December 2019. New locations, dates and times will be announced at a later date.

 

Webinars

2019 Webinars

2019 Webinars

NC Medicaid Managed Care Update - Sept. 24, 2019