December Provider Digest

AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. You will find the following topics in this digest:

RESOURCES

TRAINING

Impacting Prenatal Care in North Carolina

According to America’s Health Rankings 2021, North Carolina ranks 29th in the nation for adequate prenatal care. Early initiation of prenatal care can be enhanced by improving access to care, insurance coverage, and expanding patient education and outreach. People should be taught about how early prenatal care is an important and routine aspect of preconception care. People also benefit from understanding the signs of pregnancy and where to access testing to confirm pregnancy early in the gestation.

The North Carolina Department of Health and Human Services requires that ACNC and other PHPs create and implement performance improvement projects (PIPs) aimed at impacting specific clinical focus areas including Timeliness of Prenatal and Postpartum Care (PPC).

ACNC’s goal for the PIP is to improve the rate of prenatal and postpartum care for all pregnant people, with particular attention to identifying, addressing, and eliminating inequities that lead to health disparities among marginalized populations. To improve the percentage of members who are pregnant and receiving timely care, ACNC is: 

  • Supporting providers to increase the completion of the Pregnancy Risk Screening Form
  • Supporting optimal management and connection to resources for members who are currently pregnant, are planning to become pregnant, and have recently given birth
  • Supporting care gap closure for pregnant people and people who have recently given birth

Did you know that you can access a list of patients with pregnancy care gaps in the NaviNet portal via the PCP Performance Rollup Report found under Administrative Reports? For more information regarding billing codes specific to prenatal and postpartum care that should be submitted via claims, please visit our 2022 HEDIS® Comprehensive Provider Education Tool found on NaviNet or the Provider Resources page on our website.

Please visit our Provider Manuals, Policies and Forms page to access the Pregnancy Risk Screening Form (PDF). If you have questions about how you can submit supplemental clinical data to ACNC or close care gaps via the Care Gap Response Form in NaviNet, please contact your assigned Account Executive.

North Carolina Incident Response Improvement System (NC IRIS) — Tips for Users

We have included some helpful tips for maintaining compliance with critical incident reporting in NC IRIS.

Timely Critical Incident Reporting:

  • Level II and III critical incidents must be submitted in NC IRIS within 72 hours of learning of the incident.
    • Exceptions: 
      • Level III Reports also require a verbal report to ACNC immediately.
      • Death within 7 days of seclusion or restraint requires an NC IRIS report immediately.
  • Critical incidents initiated in NC IRIS within the 72-hour required time frame that are not submitted are not considered timely unless submitted within the required time frame.
  • If you see a thumbs up, the "Supervisor Actions " section is complete, and submission is confirmed.
  • Print or make a note of the incident number so that you can easily access the report when you have the necessary information to update and complete the report.

Level III Incident Reporting:

  • Complete an Internal Team Review and upload/attach the findings to the critical incident report.
  • Death Reporting:
    • ACNC is unable to close the critical incident in NC IRIS without official documentation of the cause of death; therefore, behavioral health providers must:
      • Request the Medical Examiner’s Report/Autopsy Report/Toxicology Report from the North Carolina Office of the Chief Medical Examiner (OCME). You can make a document request on the OCME’s website.
      • If an autopsy was not performed, please contact the Register of Deeds Office in the county where the consumer passed away to request the death certificate. (An uncertified copy is sufficient.)
      • Once the supplemental information is received, amend the critical incident report in NC IRIS to reflect the new information, including updating the "Supervisor Actions" section (Cause of Incident/Incident Prevention).

NC IRIS Resources

http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2027%20-%20mental%20health,%20community%20facilities%20and%20services/subchapter%20g/subchapter%20g%20rules.pdf

Reminder: Appointment Wait Time Standards

Throughout the year, NCDHHS requires ACNC to complete timely wait audits to support members’ ability to schedule appointments within a reasonable amount of time. Appointment wait times refer to preventative, routine and urgent care services for prenatal, primary, specialty and behavioral health care scheduling. Please review pages 21-26 of the Provider Manual (PDF) and consider where your access could be improved.

Medical Record Data Request

The annual Healthcare Effectiveness Data and Information Set (HEDIS®) reporting period is just around the corner, and I am writing to request your cooperation with our efforts to collect medical record data for our enrollees whom you have treated.

AmeriHealth Caritas North Carolina has contracted with Inovalon to assist with the annual medical record review process. Inovalon is required to comply with Health Insurance Portability and Accountability Act (HIPAA) Privacy requirements throughout the retrieval process and is trained in medical record retrieval for HEDIS, Centers for Medicare & Medicaid Services (CMS) and state quality-reporting programs. This data collection is permitted under Health Insurance Portability and Accountability Act (HIPAA) legislation.

Covered entities, including health plans and providers, are permitted to use and disclose protected health information to carry out treatment, payment, or health care operations in accordance with the HIPAA Privacy Rule (see 45 C.F.R. §164.502 (a)(1)(ii)).

We appreciate your cooperation in working with Inovalon to schedule retrieval of any requested enrollee records. Records requested should be provided at no charge to the health plan.

If you have any questions, please reach out to Traci Stahr, Lead Data Reviewer, at (843) 414-2627. We greatly appreciate your cooperation and timely assistance with this medical record request.

RESOURCES

New North Carolina Department of Health and Human Services (NCDHHS) Incident Response Improvement System (IRIS) Website Link

IRIS sites are transitioning to the NCDHHS.gov website. NCDHHS moved the IRIS Training site in November to https://iris.ncdhhs.gov. All IRIS users should bookmark the updated live site before December 31, 2022, to ensure easy access.  

North Carolina Medicaid Standard Plan and Tailored Plan Tobacco-Free Policy Requirements

NC Medicaid has released an updated bulletin (medicaid.ncdhhs.gov) on the Standard and Tailored Plan Tobacco-Free Policy Requirements:

"With the delay of Tailored Plan launch until April 1, 2023, NCDHHS will delay the implementation of North Carolina Standard Plan and Tailored Plan Tobacco-Free Policy requirements.

"Prior to Tailored Plan launch, the Department will work with key community stakeholders, Standard Plans and Tailored Plans to revise guidance on the policy requirements. More information will be provided about the program in Spring 2023."

This means providers will have more time to have a positive and collaborative implementation process for their tobacco-free campus policies. We encourage providers to take advantage of this time to use the technical assistance and resources available through the tobacco control regional manager assigned to your county (breatheeasync.org) and through the resources available at BreatheEasyNC.org (breatheeasync.org).

Vision Services for Adults

AmeriHealth Caritas North Carolina (ACNC) has a value-added service for ACNC members. Detailed information about this benefit is provided below. Review and download the extra benefits flyer (PDF) for ACNC Members, and feel free to share with your patients.

Benefit Description:

  • Member eligibility can be verified using ACNC’s provider portal, NaviNet.
  • Provides for an additional pair of glasses and an additional eye exam every two years to adult members ages 21 – 64 in addition to the regular Medicaid benefit.
  • Vision care is a covered benefit under Medicaid managed care. Any claim for a vision exam should always be billed to ACNC.

Nash Optical — First Pair of Glasses:

  • Per North Carolina state law, to qualify for this benefit, members must have received their first pair of glasses through Nash Optical, the state supplier.
  • Vision providers should check the NC Tracks system to confirm that a pair of Medicaid fee-for-service glasses has been dispensed to the member within two years before the value-added benefit can be used. 
  • If the provider has a question regarding the Medicaid fee-for-service glasses, it should be directed to the NC Medicaid Contact Center.

Electronic Visit Verification (EVV) Reminder for Home Health Care Service (HHCS) Providers

In November, ACNC shared information with HHCS providers regarding Section 12006 of the Twenty First Century Cures Act (Cures Act), and the Centers for Medicare & Medicaid Services (CMS) requires the State of North Carolina (NC) to begin utilizing an Electronic Visit Verification System (EVV) for all Home Health Care Services (HHCS) by January 1, 2023. 

A soft launch date for January 1, 2023, means that all HHCS providers are expected to show signs of readiness by the beginning of 2023. EVV claims payments will not begin until the hard launch date, April 1, 2023, when all HHCS in NC are to be fully integrated. You can review the NCDHHS announcement on their website.

We invite providers to watch the recorded information session with ACNC vendor HHAeXchange on the training page of HHAeXchange website. 

Help Members Prepare for End of the Federal Public Health Emergency

While we do not know when the Public Health Emergency (PHE) will end, NC Medicaid wants to help beneficiaries, providers and community stakeholders understand any potential impacts and steps they can take to be ready. A new webpage has launched to help providers offer guidance on preparing for the end of the PHE. Visit the new NC Medicaid webpage for resources and a communications toolkit for community partners who work closely with beneficiary. Visit NCDHHS Special Bulletin #263 for additional information.

TRAINING

Announcing 2023 Substance Use Disorders (SUD) TeleECHO® Clinic

ACNC, in collaboration with Project ECHO®, is excited to offer a 10-part training series on substance use disorders. Project ECHO is a flexible practitioner-to-practitioner, case-based virtual learning tool that functions like "virtual chart rounds" where practitioners present de-identified patient cases for peer mentoring and guided practice. As information is shared, practitioners develop expertise in new areas of care. This allows our members to get better care from primary care practitioners in AmeriHealth Caritas North Carolina they already know and trust, right in their community.

The Extension for Community Healthcare Outcomes (ECHO) model was developed by the University of New Mexico Health Sciences Center and is now used nationwide and internationally.

Clinic Objectives:

Based on literature around trauma-informed care, the Project ECHO curriculum will be developed to achieve the following objectives:

  1. Discuss educational opportunities to increase awareness and education on the impact of substance use disorders (SUD) among members and the community.  
  2. Identify resources to assist members with MAT (Medication-Assisted Treatment), Detox, IOP (Intensive Outpatient Program), and PHP (Partial Hospitalization Program).
  3. Learn about resources and tools to help providers identify substance use disorders/substance abuse in members.

Training Dates:

The 2nd and 4th Thursdays from January through April 2023, from Noon – 1:00 p.m. Register for the series. Substance Use Disorder (SUD) TeleECHO Training Series Flyer (PDF)

Earn CMEs/CNEs with Our No-Cost Training Presented by Physicians for Social Responsibility

You are invited to Cooking with Gas: Health Harms from Gas Stoves, a webinar training, presented by Physicians for Social Responsibility (PSR). This instructor-led training will examine the impact of environmental injustice, the increased risk of disease, and the dangers of indoor air pollutions to our most vulnerable populations.

This unique training is being offered at no cost for ACNC providers. Providers can earn CME/CNE credit upon completion of the training session. *

Multiple training sessions are being offered beginning December 15, 2022, through March 16, 2023. To register in advance for a date and time that’s convenient, visit our Featured Training webpage.

Collaborative Care Model (CoCM) Training Series

The North Carolina Department of Health and Human Services (NCDHHS) has partnered with NC AHEC to provide educational and practice-based support to primary care practices interested in implementing the Collaborative Care Model (CoCM) — a team-based, interdisciplinary approach to deliver evidence-based diagnoses, treatment, and follow-up care for patients with mild to moderate behavioral health needs.

The CoCM Training Series includes the following objectives:

  • Describe the principles of Collaborative Care.
  • Identify key concepts and care roles of effective implementation of Collaborative Care.
  • Explain the use of and evidence for measurement-based care.

The 10-module series will be released monthly and will provide you with the initial steps to implement CoCM and the tools for ongoing support. Contact hours, CEUs, NASW-NC Contact Hours, AMA PRA Category 1 Credit™, and NBCC will be offered. Module 2: Laying the Foundation for Collaborative Care Through Practice Transformation is now available. Learn more on the AHEC website.

Register now for the training series.

Solution for Online Prior Authorizations — Register for Training Dates

ACNC has worked with NantHealth | NaviNet to bring you Medical Authorizations, a robust, intuitive, and streamlined online authorizations workflow.

In addition to submitting and inquiring on existing Authorizations, you will also be able to:

  • Verify if No Authorization is Required.
  • Receive Auto Approvals, in some circumstances.
  • Submit Amended Authorization.
  • Attach supplemental documentation.
  • Sign up for in-app status change notifications directly from the health plan.
  • Access a multi-payer Authorization log.
  • Submit inpatient concurrent reviews online if you have Health Information Exchange (HIE) capabilities. (Fax is no longer required.)
  • Review inpatient admission notifications and provide supporting clinical documentation.

Want to learn more about Medical Authorizations? Video tutorials and step-by-step instructions will be available via the NaviNet Plan Central page and the NantHealth Help Center. ACNC is now offering training January – March 2023. Visit our Provider Training webpage for registration links for the following Wednesdays from Noon – 1:00 PM: February 15, March 15 and April 19, 2023.

Early Periodic Screening, Diagnostic and Treatment (EPSDT) Video Training

Join presenter, Yalanda Thomas, an EPSDT Manager with AmeriHealth Caritas Family of Companies who will orient viewers on the Oral Health Periodicity Schedule, patient screening visits, referral requirements and more. This training is now on our website for review.

Providers