June 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

MEET OUR TEAM

Help Patients with Medicaid Recertification

During the COVID-19 Public Health Emergency (PHE), states were not allowed to terminate or reduce Medicaid benefits. With the end of the PHE, states can terminate or reduce Medicaid benefits based on an eligibility determination for each member. All Medicaid members must be recertified for Medicaid eligibility by their local Department of Social Services (DSS) each year before their annual coverage end date. Beginning July 1, those who are no longer eligible for Medicaid or who have not responded to requests for information from their local DSS may lose their coverage.

Please encourage patients in any Medicaid plan to make sure DSS has updated address, phone, and email information, as well as information on 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.

Check out our recertification webpage for additional information.

Behavioral Health Clinical Coverage Policy Update

As a part of North Carolina’s 1115 SUD Waiver implementation, Clinical Coverage Policy (CCP) 8B and the state-funded service definition for “Inpatient Behavioral Health Services” have been amended to align with The American Society of Addiction Medicine (ASAM) Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (Third Edition, 2013). The amended Medicaid policy and state-funded definition for “Inpatient Behavioral Health Services” is found on the North Carolina Department of Health and Human Services (NCDHHS) website. 

Electronic Visit Verification Mandatory for Home Health Services Providers on July 1

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 on or before June 30. As a reminder, all Home Health EVV claim information for ACNC members must be submitted through HHAeXchange. Please use the links below to register with HHAeXchange or contact ncsupport@hhaexchange.com for assistance.

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

Please visit the NCDHHS Medicaid bulletin dated March 13, 2023, for details, revenue codes and services for claims subject to EVV.

Tobacco Cessation Counseling Services Available to All Members

Quitting isn’t easy, but members can do it! With the support of the Quit for Life® program, AmeriHealth Caritas North Carolina members can get the tools and support they need to quit smoking and vaping. Quit for Life can provide:

  • A personal quit plan created by the member and a Quit Coach
  • A quit guide to help the member during their journey to becoming tobacco-free
  • Access to a web portal to help members track progress and connect with others
  • Access to tobacco cessation medicines like nicotine gum or patches
  • Text message reminders and support from Text2QuitSM. (Standard messaging and data fees may apply.)
  • Access to a secure mobile app to help prepare to quit, track urges and contact a Quit Coach.

To refer members to the Quit for Life program, visit:

For more information or materials to support members quitting tobacco and living a healthy lifestyle, please contact your Provider Network Account Executive.

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.

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

Nursing Services for Sexually Transmitted Infection Treatment Prior Authorization Clarification

Since our beginning, ACNC has not required Prior Authorizations for the below services and codes. ACNC is in the process of updating our Prior Authorization Lookup Tool 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.

RESOURCES

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

All providers that provide EPSDT services are encouraged to watch the about 18-minute-long EPSDT training on our website 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. This information also will be made available on the Prior Authorizations page on our website.

See our Newsletters and Updates webpage for recent emailed provider notices.

Electronic Funds Transfer Through Change Healthcare Is FREE

ACNC contracts with Change Healthcare and ECHO® Health, Inc., to administer electronic funds transfer (EFT) payments and electronic remittance advice (ERA). There should be no fees associated with these transactions.

 If your practice has not yet registered for EFT, there are no fees for single payer agreements. Enroll with the following 2 steps:

  1. Use this fillable PDF form to complete the necessary information.
  2. Email the form to edi@echohealthinc.com.

As a reminder, Medical and Behavioral payment cycles run Monday, Wednesday and Friday. Pharmacy payment cycles run every four days. If you have any questions or are experiencing any problems with payments or registration, please contact our Provider Network Management Team.

TRAINING

Health Equity, Cultural Competency and Survey Attestation

At ACNC, health equity is a company-wide priority, and multidepartment committees work together to monitor, evaluate and improve processes and activities to help ensure members receive high-quality culturally and linguistically appropriate services (CLAS). This work enables ACNC to define and structure member and provider outreach, collect consistent data, develop policies and set program goals. 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.

The health plan has multifaceted, comprehensive culturally and linguistically appropriate services (CLAS) training programs for providers. ACNC educates network providers about cultural competency during site visits and orientations, and in the Provider Manual. The online provider portal also includes education tools on culturally competent care. ACNC can help when your practice has questions about delivering effective health services to diverse populations.

The ACNC Cultural Awareness and Responsiveness training page is online with links to continuing medical education (CME) resources. Please take this attestation survey when complete.

New and Ongoing Training Opportunities

Electronic Claims and 275

ACNC accepts ANSI 5010 ASC X12 275 attachments (solicited and unsolicited) via our preferred vendor Change Healthcare. Spend 7 minutes and watch this self-paced Medical Attachments video on how to use the portal, making it easier to submit documentation with your claims.

This month, we launch a follow up to our Provider Orientation training called Registering for and Using NaviNet. Learn how to determine member eligibility and benefits, locate care gaps reports, file a grievance or appeal, inquire about claims status and handle ACNC prior authorizations online.

Provider Orientation: Let’s Work Together

Held the 2nd Tuesday, Monthly from June to December 2023

Noon – 1 p.m.
Registering for and Using NaviNet

Held the 4th Tuesday, Monthly from June to October 2023

1 p.m. – 2 p.m.

ACNC Meets Providers Face-to-Face

ACNC Provider Network Manager Chelsea Arsenault (far right) enjoyed meeting providers from Carolina Neurosurgery & Spine Associates at the North Carolina Medical Group Management Association (NCMGMA) Spring Conference!

Our team had a great time at the NC Community Health Center Association’s (NCCHCA) 44th Annual Primary Care Conference in Durham. (L to R) Provider Network Manager Aja Berry is pictured with Renee Bannerman and Alice Pollard from NCCHCA, and Provider Network Account Executive Desirée Bobbitt.

Our team had a great time at the NC Community Health Center Association’s (NCCHCA) 44th Annual Primary Care Conference in Durham. (L to R) Provider Network Manager Aja Berry is pictured with Renee Bannerman and Alice Pollard from NCCHCA, and Provider Network Account Executive Desirée Bobbitt.
Providers