August Provider Digest

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

You will find the following topics in this digest:

• Triad Community Baby Shower Invitation: Greensboro Wellness & Opportunity Center Event
• Physical Health and Chronic Conditions: ACNC Clinical Leadership Forum

MEET OUR TEAM

• Provider Network Management Leadership

DEADLINES AND EXTENSIONS

• COVID-19 Coverage Updates
• Home Health Care Service Providers – Claim Reimbursement Change Effective October 1
• NC Medicaid Reminder: Provider Reverification

TRAINING

• How to Save up to 16 minutes Submitting Prior Authorizations
• Personal Care Service (PCS) and Electronic Visit Verification (EVV) Providers to Manage Diagnosis Codes in the HHAeXchange Provider Portal
• QuitlineNC & Vape Free: Text, Talk or Type, Help Your Clients Quit Their Way
• On-Demand Video Training: Electronic Claims and 275

MEMBER BENEFITS SPOTLIGHT

• There’s an App for that: Personalized Tobacco Cessation Coaching

Triad Community Baby Shower Invitation: Greensboro Wellness & Opportunity Center Event

ACNC is hosting a baby shower at our Greensboro Wellness & Opportunity Center, and we ask you to help us spread the word to expecting and new moms and families in the Triad Region. The event is Saturday, Sept. 16, from 11 a.m. to 1 p.m., at our center located at 3018 West Gate City Blvd, Greensboro, NC 27403. 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.

Physical Health and Chronic Conditions: ACNC Clinical Leadership Forum

ACNC is pleased to provide an opportunity for providers to engage with our clinical and behavioral health leaders each quarter to discuss quality improvement activities, associated challenges and best practices related to quality and population health outcomes.

The topic for Wednesday, September 13, 2023, from noon to 1 p.m., will be Physical Health and Chronic Conditions, including:

• Diabetes, Hypertension and Asthma
• Primary Care Physician Total Cost of Care (PCP TCOC) Program and Resources
• Best Practice Spotlight Featuring a Network Provider

December’s topic is Health Equity and Social Determinants of Health. Register here for one or both dates.

MEET OUR TEAM

Provider Network Management Leadership

Kristen Kanach

Director of Provider Network Management

Kristen Kanach joined AmeriHealth Caritas North Carolina as Director of Provider Network Management in January 2023. In this role, she oversees the staff that manages relationships and contracts with AmeriHealth Caritas’ network of providers in North Carolina.

Before joining AmeriHealth Caritas North Carolina, Kanach worked with a San Francisco-based independent practice association and UnitedHealthcare. She has more than 16 years of experience in the health care industry, primarily in network management.

Kanach holds a bachelor’s degree from the University of California, Los Angeles (UCLA). She is a California native who recently relocated to Charlotte with her family.

Reneé Simmons

Director of Provider Network Management, AmeriHealth Caritas Next Plan

Reneé Simmons was named Director of Provider Network Management in February 2023. She works with Kristen Kanach to oversee the Provider Network Management team that supports both the AmeriHealth Caritas North Carolina Medicaid plan and the AmeriHealth Caritas Next Health Insurance Marketplace plan.

Simmons has been with the AmeriHealth Caritas Family of Companies since 1996. Before coming to North Carolina, she held various positions with our plans in South Carolina and Louisiana. As Manager of Provider Network Operations at Select Health of South Carolina, she was responsible for the Provider Disputes Team, Provider Network Coordinators and the Coordinator for Contract Management.

Simmons holds a bachelor’s degree from Southern Wesleyan and is also an alum of the University of South Carolina. In her free time, she enjoys reading and spending time with her family.

DEADLINES AND EXTENSIONS

COVID-19 Coverage Updates

NC Medicaid has extended coverage for COVID-19 vaccination administration, counseling, and over-the-counter tests through September 30, 2024. Please refer to NCDHHS Special Bulletin COVID-19 #268, dated July 14, 2023.

Home Health Care Service Providers – Claim Reimbursement Change Effective October 1

All Home Health Care providers are expected to be fully compliant with Electronic Visit Verification requirements by Oct. 1, 2023. As of that date, all Home Health EVV claim information for ACNC members must be submitted through HHAeXchange or they will be denied. Please use the links below to register with HHAeXchange or contact ncsupport@hhaexchange.com for assistance.

PCS and EVV providers are invited to a live training webinar on Wednesday, September 6, 2023, at 10:00 am.

Providers can also view the following self-paced training webinar, NC PHP’s Home Health Billing Overview.

Please visit the NCDHHS Medicaid bulletin dated July 20, 2023, for details on the extended deadline.

NC Medicaid Reminder: Provider Reverification

Re-credentialing/reverification is an evaluation of a provider’s ongoing eligibility for continued participation in NC Medicaid. The Affordable Care Act mandates that providers be recredentialed every five years. NC Medicaid notifies providers of their recredentialing due date via the message center inbox in the NCTracks secure provider portal.

Providers who do not complete the recredentialing process on time will be suspended from Medicaid program participation. The provider will be terminated from the NC Medicaid program following 50 days of suspension. For convenience, NC Medicaid has posted a list of dates (updated biannually).

Providers are encouraged to review the reverification due date list, and frequently check your Provider Message Inbox for notifications or the reverification section of the Status and Management page in the NCTracks Secure Portal for the option to reverify. Find more information on the NCDHHS website or contact the NCTracks Call Center at 1-800-688-6696 for assistance.

TRAINING

How to Save up to 16 Minutes Submitting Prior Authorizations

Are you a health care provider or clearinghouse looking to save time and move away from paper prior authorizations? If you’ve signed up for the NaviNet provider portal, are you using all its functionality? Maybe you have multiple claims needing attention and didn’t realize you can save up to 16 minutes per submission using the NaviNet provider portal instead of fax.

Sign up for our newest live webinar: Registering for and Using NaviNet. This training helps providers understand how efficient the provider portal, NaviNet, is for member eligibility and benefits, locating care gap reports, filing a grievance or appeal, inquiring about claims status, and handling our plan’s prior authorizations — all online. This training is being offered the fourth Tuesday of each month through November. Register to learn more.

Personal Care Service (PCS) and Electronic Visit Verification (EVV) Providers Can Manage Diagnosis Codes in the HHAeXchange Provider Portal

Personal Care Service (PCS) and Electronic Visit Verification (EVV) Provider claims are paid according to your contracted rate with ACNC. ACNC allows PCS and EVV Providers to manage and enter the correct DX Code for the Billing Diagnosis Code field in the HHAeXchange Provider Portal.

• The Provider-Managed Billing Diagnosis Code Job Aid (PDF) provides guidance on how to enter the diagnosis codes for all linked contracts.
• If you need to manually update the rate, review the Rate Management Job Aid (PDF).
• If an update is made, your agency is responsible for managing the rate, including any contractual updates, going forward.
• Providers can review the default rate on the Department of Health and Human Services (DHHS) fee schedule.

QuitlineNC & Vape Free: Text, Talk or Type, Help Your Clients Quit Their Way

On September 13, from 11:30 a.m. to 1 p.m., become familiar with all of QuitlineNC’s services, including new ways clients can connect with coaches. Also covered: programs for pregnant women, American Indian QuitlineNC, the behavioral health program and more.

Learn about Live Vape Free, a service that helps adolescents quit vaping through live coaching via text, phone or online. 1.5 CEUs approved by the NCASPPB. Please register here.

On-Demand Video Training: Electronic Claims and 275

ACNC accepts ANSI 5010 ASC X12 275 attachments (solicited and unsolicited) via our preferred vendor, Change Healthcare. Spend seven minutes and watch this self-paced Medical Attachments video on how to use the portal, making it easier to submit documentation with your claims.

MEMBER BENEFITS SPOTLIGHT

There’s an App for that: Personalized Tobacco Cessation Coaching

ACNC members have access to tobacco cessation services at no charge through the Quit for Life^® program. In addition to personalized support services and smoking cessation medicines, enrolled members also can use a secure mobile app to prepare to quit, track urges, and even attend group sessions. The Rally Coach app is available for all Smart Phone Apple and Android users.

To refer a patient to Quit For Life, please visit the ACNC Quit For Life page and click the Refer A Patient link in the top navigation line.