April Provider Digest

AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve.

You will find the following topics in this digest:

• Ending Clinical Policy Flexibilities Associated with the Federal Public Health Emergency
• NC Medicaid Electronic Visit Verification Now Active for Home Health Care Services Providers
• Change Healthcare (ConnectCenter™) New User Guide Links
• End of Public Health Emergency (PHE) – Help Patients with Redetermination
• Tailored Plan launch delayed until October 1, 2023
• Charlotte Mecklenburg Baby Shower Invitation: ACNC Wellness & Opportunity Center Event

PHARMACY

• NC Medicaid Preferred Drug List Release: April 1, 2023

UPDATED RESOURCES

• Provider Manual 2022 Clarifications

TRAINING

• New and Ongoing Training Opportunities

Ending Clinical Policy Flexibilities Associated with the Federal Public Health Emergency

We encourage providers to read the NCDHHS Special Bulletin COVID-19 #265 to understand flexibilities that have been or are being incorporated into permanent policy. The bulletin also includes details on which flexibilities will be sunsetting. Please note that some flexibilities are ending on or after May 11, 2023, concurrent with the end of the Federal Public Health Emergency.

NC Medicaid Electronic Visit Verification Now Active for Home Health Care Services Providers

As of April 1, NC Medicaid Direct home health care services (HHCS) providers who provide the following services should be using electronic visit verification (EVV) for personal care services (PCS) and for HHCS: home health aide services, physical therapy, occupational therapy, speech therapy and skilled nursing visits. Per guidance from the NC Department of Health and Human Services, providers have until June 30 to complete implementation of the EVV system. A hard launch will begin July 1, 2023; after that date, claims without the required EVV criteria will be denied.

Section 12006 of the 21st Century Cures Act required the North Carolina Department of Health and Human Services (NCDHHS) to begin using an EVV system for PCS and for HHCS by April 2023. EVV uses technology to record the times, dates and specific services that are given. This helps make sure people who should receive services, in fact, receive them.

Please visit the NCDHHS Medicaid bulletin dated March 31, 2023, for details, revenue codes, and services for claims subject to EVV.

Change Healthcare (ConnectCenter™) New User Guide Links

As of March 31, Change Healthcare updated all ConnectCenter™ Electronic Claims User Guide links throughout their provider systems and communication materials. Prior Electronic Claims User Guide links no longer work. Updated links are on the ACNC Claims and Billing webpage and below for your reference.

The following new links should be updated or bookmarked in your internet browser:

• Enrollment Central (PDF)
• Claims – Getting Started (PDF)
• Claims – Status (PDF)
• Claims – Uploading a Claim (PDF)
• Create a Claim video link
• Eligibility – Getting Started (PDF)
• Keying Institutional Claims (PDF)
• Keying Professional Claim (PDF)
• Provider Management - Getting Started (PDF)
• Provider Sign-up and User Management (PDF)
• Remits - Getting Started (PDF)

End of Public Health Emergency (PHE) – Help Patients with Medicaid Recertification

As of April 1, states are required to resume redetermining eligibility, also known as recertification or renewal, for all Medicaid beneficiaries. After several years of continuous Medicaid coverage during the PHE, the renewal process may be unfamiliar to many beneficiaries. 

Please encourage patients in any Medicaid plan to make sure their local Department of Social Services (DSS) has updated address, phone and email information as well as any life changes such as income or a change in household (for example, if a member got married or divorced). This will help ensure that beneficiaries get the right information and act on time to prevent any gaps in health care coverage.

Medicaid members can update this information directly with their local DSS or via the state’s online portal, ePASS. ePASS is North Carolina’s secure self-service website where beneficiaries can apply for various benefits, view case details, renew their Medicaid and update information. For more information and step-by-step instructions, see the downloadable fact sheet in English and in Spanish: What is ePASS? How to sign-up for an Enhanced ePASS account .

Tailored Plan launch delayed until October 1, 2023

North Carolina has delayed the launch of the NC Medicaid Managed Care Behavioral Health (BH) and Intellectual/Developmental Disabilities (IDD) Tailored Plans (TPs) until October 1, 2023. According to NC DHHS, the delayed start allows Local Management Entity (LME)/Managed Care Organizations (MCOs), which will operate the Tailored Plans, more time to contract with additional providers to ensure a smooth transition for members and their care. People who will be covered by the Tailored Plans will continue to receive care through their existing plans until the new fall launch date.

Tailored Plans offer health plans to individuals with significant mental health (MH) and substance use disorder (SUD) needs, intellectual/developmental disabilities (IDD), and traumatic brain injuries (TBI).

ACNC has an agreement with Sandhills Center, which is responsible for an 11-county region, to provide a physical health network to support Tailored Plan members. To locate additional information regarding this delay, visit the NCDHHS press release.

Charlotte Mecklenburg Baby Shower Invitation: ACNC Wellness & Opportunity Center Event

ACNC is hosting a baby shower at our Charlotte Wellness Center, and we ask you to help us spread the word to ACNC expecting and new moms and families in Mecklenburg County. The event is Saturday, May 20, from 11 a.m. to 1 p.m. at our center, located at 3120 Wilkinson Boulevard, Charlotte, NC 28208. Please share with your patients and encourage them to RSVP.

We encourage you to refer members to our Wellness & Opportunity Centers around the state. Visit our Community webpage and look for Wellness & Opportunity Centers to find links to event calendars.

PHARMACY

NC Medicaid Preferred Drug List Release: April 1, 2023

The preferred drug list (PDL) is updated twice yearly, in April and October. Visit the NC DHHS Division of Health Benefits for the latest PDL updates.

UPDATED RESOURCES

Provider Manual 2022 Clarifications

We’ve had questions regarding inconsistencies on Prior Authorization requirements in the 2022 Provider Manual posted on our website. The state-approved 2023 version of the manual will not be posted until later this year. Areas of clarification include:

Home-based services requiring prior authorization:

• Home health care (physical, occupational, and speech therapy), as well as skilled nursing. After 18 combined visits, regardless of modality
• Home infusion services and injections
• Home health aide services
• Private duty nursing (extended nursing services)
• Personal care services

Specialized Therapies requiring prior authorization:

• Physical, Occupational, and Speech Therapy — Home Health Care services. After 6 combined visits, regardless of modality.
• Physical, Occupational, and Speech Therapy — Private and Outpatient Facility-based services. After the first 12 visits per modality, per calendar year.
• Please download our Provider Prior Authorization Guide (PDF) as a reference.

Appeals and Grievances: ACNC Timeline to Respond

For both provider and member appeals and grievance, ACNC will provide a written notice of resolution of the appeal as expeditiously as the member’s health condition requires and no later than sixty (60) calendar days after receiving the appeal.

New or Ongoing Training Opportunities

Personal care service (PCS) and electronic visit verification (EVV) providers can now manage the Billing Diagnosis Code field and edit rates per contracted amounts in the HHAeXchange Provider Portal. PCS and EVV providers are invited to view a nine-minute webinar,

In June, we will launch a follow up to our Provider Orientation training with a demonstration called Registering for and Using NaviNet. In this training you will learn how to determine member eligibility and benefits, inquire about claims status and how to handle ACNC prior authorizations online.