November Provider Digest
AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. A Known System Issues Tracker is updated weekly and also available in NaviNet to providers.
You will find the following topics in this November digest:
QUALITY CORNER
CLAIMS AND BILLING
FORUMS AND SURVEYS
ACNC Mobile Wellness and Opportunity Center Responds to Disaster Needs
Our Mobile Wellness and Opportunity Center has been on the road to deliver supplies and support outreach to members in hard-hit areas. The bus is equipped with mobile phone charging stations, computer and internet access, a space to treat minor injuries, and wheelchair access, and it is heated and air conditioned. We continue to evaluate opportunities to deploy this important resource to support continued access to care and services for our members in western North Carolina. Read more about the provider and community relief efforts ACNC put into place in Issue 3 of CONNECTIONS, our once-a-year digital and printed magazine, available in early December.
November Is National Diabetes Month!
Over 37 million Americans are living with diabetes, and it is important to provide education and programs to empower patients to learn more about disease management and prevention.1
The National Institute of Diabetes and Digestive and Kidney Diseases has a toolkit with tips and tricks to help prevent diabetes health problems. Flyers in English and Spanish and the full toolkit can be found by following this link.
AmeriHealth Caritas North Carolina (ACNC) continues to educate and encourage members to obtain proper screenings, such as blood pressure checks, A1c testing, diabetic eye exams, and wellness exams, as suggested by the member’s treating provider. Members living with diabetes are eligible to receive $10 once a year for a dilated eye exam and $10 twice a year for A1c results of 9.0 or less. ACNC also collaborates with providers to assist with member screenings and medication adherence. If you or your practice is interested in collaborating with ACNC for diabetes management, please contact us via email at acncqualitymanagement@amerihealthcaritas.com.
1“National Diabetes Month 2024 Toolkit,” National Institute of Diabetes and Digestive and Kidney Diseases
Supporting Definitions for Orthotics, Prosthetics and Supplies
Medically necessary orthotic and prosthetic devices are covered by the Medicaid program when prescribed by a qualified licensed health care practitioner and supplied by a qualified provider. Only items determined to be medically necessary, effective and efficient are covered. A qualified orthotic and prosthetic device provider must be approved by the Division of Medical Assistance. Review the updated Medicaid Clinical Coverage Policy 5B, Orthotics and Prosthetics requirements published September 17, 2024. Below are some helpful definitions for reference.
Custom fabricated – A custom-fabricated item is one that is individually made for a specific patient. No other patient would be able to use this item. A custom-fabricated item is a device which is fabricated based on clinically derived and rectified castings, tracings, measurements and/or other images (such as X-rays) of the body part. The fabrication may involve using calculations, templates and components. This process requires the use of basic materials including, but not limited to, plastic, metal, leather or cloth in the form of uncut or unshaped sheets, bars or other basic forms and involves substantial work such as vacuum forming, cutting, bending, molding, sewing, drilling and finishing prior to fitting on the patient.
Prefabricated — A prefabricated orthosis is an item that is manufactured in bulk. A prefabricated orthosis may be considered an Off the Shelf (OTS) or a custom-fitted device that may be trimmed, bent, molded (with or without heat) or otherwise modified for use by a specific beneficiary. An orthosis that is assembled from prefabricated components is considered prefabricated. It is inherent in the definition of prefabricated that a particular item is complete.
Custom fitted — These devices are prefabricated orthosis manufactured in bulk. These devices are considered custom fitted when they are trimmed, bent, molded (with or without heat) or otherwise modified for use by a specific beneficiary. Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary.
Off the shelf — These devices are prefabricated orthosis manufactured in bulk. Off-the-shelf items require minimal self-adjustment for fitting at the time of delivery for appropriate use and do not require expertise in trimming, bending, molding, assembling or customizing to fit an individual.
2024 Provider Satisfaction Survey
You may have received a request to complete a provider satisfaction survey to help us gain insight into how we are doing. The survey will take about 15 minutes to complete. Results from the survey will be used to guide administrative and operational changes to our health plan and point out areas that might need improvement.
If you receive the welcome letter and survey in the mail, there are two ways to complete the survey:
- Online, using the credentials given in the letter by going to SPHSurvey.com
- Complete the enclosed survey and return it using the prepaid envelope.
Thank you for your continued partnership with ACNC in the service of our members and for your critical role in providing and coordinating care for them.