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Health Plan Networks: Enrolling and Assigning Beneficiaries to Health Plans and PCP Practices

The Department encourages beneficiaries to enroll in a health plan with the providers they want already in its network. This makes it easier for beneficiaries to continue getting, and for providers to continue managing, the care they need. During open enrollment, beneficiaries have until December 13, 2019 to enroll in a health plan and select their Primary Care Provider (PCP)/ Advanced Medical Home (AMH). Beneficiaries will have a 90-day choice period from the health plan effective date to change health plans. Beneficiaries who do not choose a health plan or PCP during open enrollment go through an automatic enrollment and assignment process, described below.

How Health Plan Auto-Enrollment is Affected by Beneficiary-PCP Relationships

Beneficiaries are automatically enrolled in a health plan if they do not choose one during open enrollment. Beneficiaries are enrolled first in the health plan with their PCP/AMH’s practice in its network, followed by other criteria set by DHHS. 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 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.

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

Meet and Greets

NC Medicaid Provider Services is partnering with NC AHEC to host Health Plan Meet and Greet sessions across the state. NC Medicaid consultants will be onsite to address your concerns and questions about the transition from Medicaid fee-for-service to Medicaid Managed Care. Meet and Greet sessions are structured as conversations between providers and Medicaid Managed Care Health Plan staff. Presentations are not planned. Feel free to drop-in at any time during the sessions. 

Health Plan Meet and Greet Sessions

Date Time Address Registration More Information
Dec. 4, 2019  7:30 a.m. - 1:30 p.m. 3rd Floor Education Center, Classrooms A-E
1601 Owen Drive, Fayetteville, NC 28304
Register More Information
Dec. 5, 2019 7:30 a.m. - 1:30 p.m. McKimmon Conference Center
1101 Gorman Street, Raleigh NC 27606   
Register More Information
Dec. 6, 2019 7:30 a.m. - 1:30 p.m. Sentara Albemarle Medical Center Education Room 
1144 N Road Street, Elizabeth City, NC 27909   
Register More Information
Dec. 9, 2019 7:30 a.m. - 1:30 p.m. Dr. David M. Webb Learning Institute, Rooms A, B, C
1631 S. Wesleyan Boulevard, Rocky Mount, NC 27804
Register More Information
Dec. 10, 2019 7:30 a.m. - 1:30 p.m. 2600 West Arlington Boulevard, Greenville NC 27835 Register More Information
Dec. 11, 2019 7:30 a.m. - 1 p.m. Pelican Classroom                                                      
2511 Delaney Avenue, Wilmington NC 28403
Register More Information
Dec. 13, 2019 7:30 a.m. - 12 p.m. Alamance Regional Campus, Room 101
1236 Huffman Mill Road, Burlington, NC 27215
Register More Information
Dec. 16, 2019 7:30 a.m. - 1:30 p.m. MAHEC Education Building, Blue Ridge Room
121 Hendersonville Road, Asheville, NC  28803   
Register More Information
Dec. 17, 2019 7:30 a.m. - 1:30 p.m. McCreary Tower, Wake Forest BB&T Field                     
475 Deacon Boulevard, Winston-Salem NC 27105
Register More Information
Dec. 18, 2019 7:30 a.m. - 1:30 p.m. Charlotte AHEC, Center for Learning and Development - Building K
5039 Airport Center Parkway, Charlotte, NC 28208
Register More Information

 

Webinars

2019 Webinars

2019 Webinars

NC Medicaid Managed Care Update - Sept. 24, 2019