July Provider Digest

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

You will find the following topics in this digest:

• NC Medicaid Reminder: Provider Reverification Resumes
• Home Health Care Service Providers – Claim Reimbursement Change Effective October 1
• Registration is now open for the 3rd Annual Virtual Statewide Quality Forum
• 2023 ACNC Clinical Leadership Forums

RESOURCES

• Tobacco-Free Campus Signs Offered by BreatheEasyNC
• Nursing Services for Sexually Transmitted Infection Treatment Prior Authorization Clarification

PHARMACY

• Reminder: Follow State Guidelines When Submitting 340B Claims for Payment

TRAINING

• How to Support Clients and your Organization to Become Tobacco-Free
• You Quit, Two Quit: Helping Clients Become Tobacco-Free Before, During and After Pregnancy
• Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Information and On-demand Training
• Health Equity, Cultural Competency and Survey Attestation
• Monthly or On-Demand Trainings

NC Medicaid Reminder: Provider Reverification Resumes

Re-credentialing/reverification is an evaluation of a provider’s ongoing eligibility for continued participation in NC Medicaid, normally conducted every five years as mandated by the Affordable Care Act. However, the federal Public Health Emergency (PHE) paused reverification from March 2020 through May 11, 2023, delaying the due date for nearly 30,000 providers over that three-year period. Now that the federal PHE has ended, NC Medicaid must ensure that all enrolled providers, including those whose reverification was delayed, are compliant with the reverification requirement.

Reverification notifications are sent to the provider 70 days prior to the reverification due date, with reminders at 50 days, 20 days, and five days. Non-responsive providers then receive a notice of suspension that gives them an additional 50 days to submit their reverification application before being terminated from the program. Including the notice of termination, and depending on the provider’s responsiveness, each will receive up to six targeted notifications over a 120-day period. If terminated, the provider may re-enroll at any time.

For convenience, NC Medicaid offers a list of “Active Provider Re-Verification Due – July 2023 – Dec 2023 [medicaid.ncdhhs.gov]” dates (updated biannually). The reverification due date displayed is also the health plan suspension date of the provider record if no action is taken to submit the reverification application under the applicable NPI. If the health plan is suspended, claims payment will stop.

Providers are encouraged to review the reverification due date list, and frequently check their 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. In addition to the resources below, providers may contact the NCTracks Call Center at 800-688-6696 for assistance.

Resources:

• Provider Reverification/Recredentialing Webpage [nctracks.nc.gov]: Also contains link to the reverification due date list referenced above.
• Reverification/Recredentialing FAQs [nctracks.nc.gov]
• User Guide [nctracks.nc.gov]: “How to Complete Re-verification in NCTracks”
• NC Medicaid Provider webpage [medicaid.ncdhhs.gov]: Access to Medicaid Bulletin articles and Provider Enrollment information

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

After September 30, 2023, all Home Health Electronic Visit Verification (HHEVV) 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.

Per guidance from the NCDHHS, home health care services (HHCS) providers who provide home health aide services, physical therapy, occupational therapy, speech therapy and skilled nursing visits are required to implement the electronic visit verification (EVV) system. To offer ample opportunity for providers to register and prepare for this change, communications have been shared since last November and can be found on our website.

HHAeXchange Registration Link: https://www.cognitoforms.com/HHAeXchange1/northcarolinaphphhaexchangeproviderenrollmentform

PCS and EVV providers are invited to view a nine-minute training webinar, North Carolina PHP’s: Home Health Billing Overview

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

Registration is now open for the 3rd Annual Virtual Statewide Quality Forum

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care standard plans, will host the 3rd Annual Virtual Statewide Quality Forum on Wednesday, August 9, from noon to 1 p.m. The forum is designed to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives.

Agenda topics include:

• Performance Improvement Projects
• HIE Update
• CAHPS
• Provider Survey Results
• Administrative Simplification

Physical Health Chronic Conditions 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, will be Physical Health Chronic Conditions, including:

• Diabetes, Hypertension and Asthma
• Primary Care Total Cost of Care (PC TCOC) 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.

RESOURCES

Tobacco-Free Campus Signs Offered by BreathEasyNC

Any agency that needs new or updated tobacco-free policy signage can contact Natalie Thompson at nrthompson@dconc.gov for free signs. Be sure to include:

• Name of agency
• Contact name and email address
• Mailing address
• What county your mailing address is in

These metal signs clearly show all of the types of products that are covered by the policy (combustible, smokeless and vapes) and designate the area as tobacco-free. Signs will be allocated on a first-come-first-served basis, so be sure to contact Natalie if you need these free signs! They are available in English or Spanish.

Nursing Services for Sexually Transmitted Infection Treatment Prior Authorization Clarification

Since our beginning, ACNC has not required Prior Authorizations for the service/code listed below. ACNC is in the process of updating our Prior Authorization Lookup Tool to be consistent with this information.

• T1002 (RN services, up to15 minutes) when billed with sexually transmitted infection (STI) Diagnosis codes

If you have questions or concerns, please contact Provider Services at 1-888-738-0004.

PHARMACY

Reminder: Follow State Guidelines When Submitting 340B Claims for Payment

NC Medicaid has requirements for submitting 340B drug claims. ACNC would like to reiterate the 340B provider and claim submission requirements for both the outpatient pharmacy and physician drug programs.

Please review the September 3, 2019, NCDHHS Bulletin for additional procedure information.

TRAINING

How to Support Clients and Your Organization to Become Tobacco-Free

Register for one of two dates in 2023:

• August 1, 9 a.m. – 12:30 p.m.
• October 6, 9:30 a.m. – 1 p.m.

Learn step-by-step how to implement a tobacco-free campus policy and integrate standard-of-care tobacco use treatment at diverse programs, including inpatient, community-based, residential, and long-term services and supports.

3 CEUs approved by NCASPPB

Date	Time	Register
August 1	9 a.m. – 12:30 p.m.	Register here (Zoom)
October 6	9:30 a.m. – 1 p.m.	Register here

You Quit, Two Quit: Helping Clients Become Tobacco-Free Before, During and After Pregnancy

You Quit, Two Quit is North Carolina’s technical assistance agency for providers who want to offer evidence-based tobacco use screening and cessation counseling for women of reproductive age. Learn how to integrate tobacco screening and treatment into a clinic’s workflow, offer brief interventions for tobacco use treatment tailored for pregnant or reproductive-aged women, and considerations for treating tobacco use during pregnancy or lactation.

1.5 CEUs approved by the NCASPPB

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Information and On-demand Training

All providers that provide EPSDT services are encouraged to watch the 18-minute EPSDT training and take a quick survey. In the video, presenter Yalanda Thomas, an EPSDT Manager with AmeriHealth Caritas Family of Companies (ACFC) provides information about the Oral Health Periodicity Schedule, patient screening visits, referral requirements and more.

Please check out our new EPSDT webpage that offers helpful tips on prior authorization and claims for EPSDT services. This information is also available on the Prior Authorizations page on our website.

Health Equity, Cultural Competency and Survey Attestation

At AmeriHealth Caritas North Carolina (ACNC), health equity is a company-wide priority, and cross-departmental committees work together to monitor, evaluate and improve processes and activities to help members receive high-quality culturally and linguistically appropriate services (CLAS). This work enables AmeriHealth Caritas North Carolina to define and structure member and provider outreach, collect consistent data, develop policies and set program goals. We know that race, ethnicity, language, religion, socioeconomic status, mental health, cognitive, sensory and physical disability, gender, age, sexual orientation, gender identity, geographic location or other characteristics historically linked to exclusion or discrimination are known to negatively impact health outcomes.

ACNC offers a variety of multifaceted, comprehensive culturally and linguistically appropriate services (CLAS) training programs for providers. We educate network providers about cultural competency during site visits and orientations, and in the Provider Manual. ACNC can help when your practice has questions about delivering effective health services to diverse populations.

You can find a wide range of continuing medical education (CME) resources on our website at The AmeriHealth Caritas North Carolina Cultural Awareness and Responsiveness training page. Cultural competency training indicators are included in our provider directory for members to review. Make sure your information is up to date to take by taking this attestation survey.

Monthly or On-Demand Trainings

New! Registering for and Using NaviNet training helps providers understand how efficient the provider portal, NaviNet, is for member eligibility and benefits, locating care gaps reports, filing a grievance or appeal, inquiring about claims status and handling ACNC prior authorizations — ALL online. This training is being offered the fourth Tuesday of each month from July to October. Register to learn more.

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.