Key Dates for Transitioning to Medicaid Managed Care
- March 15, 2021 – Open Enrollment begins
- May 14, 2021 – Open Enrollment ends
- May 15, 2021 – Auto Enrollment for beneficiaries who have not selected a health plan
- May 22, 2021 (approximate) – Transition of Care information is sent to each health plan for beneficiaries assigned to that health plan
- July 1, 2021 – Medicaid Managed Care launch
Provider Contracting Deadlines
In order to be included in the Medicaid and NC Health Choice Provider and Health Plan Look-up Tool and PHP provider directories used by beneficiaries during open enrollment (March 15, 2021), providers must submit signed contracts to PHPs by Feb. 1, 2021. In order for a provider’s information to be used in auto-enrollment (May 15, 2021), contracts must be submitted to PHPs by April 12, 2021.
This allows sufficient time for signed contracts to be returned and for the PHP to process those contracts. Typically, PHP processing time is two to three weeks, but may take longer. Primary Care Providers need to contract with health plans in a timely fashion to avoid losing patients when health plans assign beneficiaries to in-network providers. More information is available here.
Ensure Your Information Displays Correctly in NC’s Provider Directory – Medicaid and NC Health Choice Provider and Health Plan Look-Up Tool
The public version of the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool is now available at: https://ncmedicaidplans.gov/. Providers are encouraged to use this tool to confirm the availability and accuracy of information contained in their NCTracks provider enrollment record.
Interim Reports to Assist Providers in Verifying Their Records
Provider Directory Listing Report
The Provider Directory Listing Report (generated June 20, 2021) contains all active Medicaid and NC Health Choice providers that will be published on the Enrollment Broker (EB) website in the Medicaid and NC Health Choice Provider and Plan Lookup Tool. This list includes Primary Care Providers (PCPs) and specialty providers who are contracted with a Health Plan and/or Tribal Option as well as providers who are not participating in managed care to reflect the NC Medicaid Direct provider population.
The report also identifies practices slated to be included in the auto-assignment process due to their participation with the Advanced Medical Home program, and gives providers the opportunity to correct erroneous demographic and affiliation data on their enrollment record in the secure NCTracks Provider Portal.
Provider Affiliation Report
The Provider Affiliation Report (generated June 20, 2021) contains all active organizations, their service location and each affiliated individual provider. This report will only display individual to organization affiliations as found in NCTracks.
- If there are no such affiliations, no information will be displayed.
- The information listed will also be used by the EB to populate their public-facing provider directory.
- Organizations should use the search function to find the practice and verify the accuracy of the affiliated providers for the location listed and identify any invalid affiliations.
- Individual providers should use the search function to validate affiliation to both the organization and the organization location.
Providers may use the NCTracks Managed Change Request (MCR) process, available in the Secure NCTracks Provider Portal, to modify any provider record or service location information as well as individual to organization affiliations. If the Provider Affiliation information is incorrect, the affiliated provider or the Office Administrator for the affiliated provider must update the group affiliation. Providers unable to find their practice associated with the correct Health Plans, should reach out directly to the Health Plan to discuss contracting options. Contact information can be found on the Health Plan Contacts and Resources webpage.
Note: A Field Description tab is available on the report to connect the section of the MCR to the field in the report displaying the information.
Additional information on updating an NCTracks provider record can be found here. Providers needing additional assistance with updating the information on their NCTracks provider record may contact the NCTracks Contact Center at 800-688-6696.
Beneficiaries began using the tool for open enrollment starting March 15, 2021
The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.
Additionally, the Ombudsman will assist providers with Health Information Exchange (HIE) inquires related to NC HealthConnex connectivity compliance and the HIE Hardship Extension process.
Provider Ombudsman inquiries, concerns or complaints can be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov, or providers may utilize the Provider Ombudsman line at 866-304-7062. The Provider Ombudsman contact information will also be published in each PHP provider manual.
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.
This support will also focus on rural and independent practices, including on-site coaching and technical assistance. For questions, email Practicesupport@ncahec.net.