March Provider Digest

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

You will find the following topics in this digest:

• Tailored Plan Launch Delayed Until October 1, 2023
• Medicaid Redetermination Process to Resume in April
• April 1 Deadline: NC Medicaid Electronic Visit Verification for Home Health Provider Readiness
• Personal Care Service (PCS) and Electronic Visit Verification (EVV) Providers to Manage Diagnosis Codes in the HHAeXchange Provider Portal
• Wellness & Opportunity Center Activities for Members
• NC Health Choice to Medicaid: Claims and Billing

PHARMACY

• Updated Preferred Drug List Release: April 1, 2023

RESOURCES

• Connecting with Your New Account Executive (AE)
• Provider Total Cost of Care (TCOC) and Quality Enhancement Program (QEP) Manuals Online
• New or Ongoing Training Opportunities
• Last Chance Training Opportunities

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 NCDHHS, the delayed start allows Local Management Entity/Managed Care Organizations (LME/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, see the NCDHHS press release.

Medicaid Redetermination Process to Resume in April

The COVID-19 Federal Public Health Emergency (PHE) provided NC Medicaid beneficiaries continuous (ongoing) Medicaid health coverage. With the passage of Omnibus Bill in December 2022, states are no longer required to maintain the continuous Medicaid coverage beginning April 1, 2023. This means states must start redetermining eligibility for all Medicaid beneficiaries.

NC Medicaid will begin the recertification (renewal) process April 1, 2023, for beneficiaries with renewal dates in June 2023. Medicaid recertification (renewal) is the way Medicaid makes sure Medicaid beneficiaries are still eligible for Medicaid health coverage.

After several years of continuous Medicaid coverage during the PHE, the renewal process may be unfamiliar to many beneficiaries. AmeriHealth Caritas North Carolina is working in partnership with the state to encourage members to make sure their local Department of Social Services has current contact information, including their mailing address, phone numbers and email address. This will help ensure that beneficiaries get the right information and take action on time to prevent any gaps in health care coverage.

For the latest information and guidance from NCDHHS, please visit their website on the end of the COVID Federal Public Health Emergency.

April 1 Deadline: NC Medicaid Electronic Visit Verification for Home Health Provider Readiness

Section 12006 of the 21st Century Cures Act requires the North Carolina Department of Health and Human Services (NCDHHS) begin using an Electronic Visit Verification (EVV) system for Personal Care Services (PCS) and for Home Health Care Services (HHS) 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 do, in fact, receive them.

This is a reminder that EVV for HHCS providers will launch on April 1, 2023. NC Medicaid Direct HHCS providers who provide the following services should be prepared to assist for a successful EVV implementation: aide services, physical therapy, occupational therapy, speech therapy, and skilled nursing visits. For more information, visit the NCDHHS EVV webpage.

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

Last month, ACNC communicated that personal care service (PCS) and electronic visit verification (EVV) providers can manage the Billing Diagnosis Code field in the HHAeXchange Provider Portal. The diagnosis codes (DX) will not be imported on any new authorizations after January 13, 2023. It will be the provider’s responsibility to manage and enter the correct DX Code for the service.

Please review the Provider-Managed Billing Diagnosis Code Job Aid, which provides guidance on how to enter the diagnosis codes for all Fidelis Care contract Authorizations. A Billing Review hold has been implemented for any authorizations that do not have a DX loaded. This process prevents any submission of blank diagnosis codes on a claim.

Also in February, ACNC allowed agencies to edit rates per contracted amounts. All claims billed to ACNC on or after February 13 will be billed at the default rate on the Department of Health and Human Services (DHHS) fee schedule. Your claims will be paid according to your contracted rate with ACNC. If this rate does not match your contracted rate and you wish to update, you can manually update the rate as explained in the Rate Management Job Aid.

Please keep in mind that if the rate is updated, your agency will be responsible for managing the rate, including any contractual updates, going forward.

For further information concerning the contents of this notification or for training to support these changes, please contact HHAeXchange Customer Support (support@hhaexchange.com).

Wellness & Opportunity Center Activities for Members

Members and families of the ACNC health plan have free access to our regional Wellness & Opportunity Centers around the state. These centers are a hub for community, collaboration and support. We invite you to visit the Community webpage and look for Wellness & Opportunity Centers to find monthly event calendars in every region.

ALL are welcome inside our centers, where you will find the following amenities:

• Food and nutritional support, including a food pantry
• Nutrition and cooking classes featuring local chefs
• Computer stations
• Health and safety awareness trainings and outreach
• Education, employment, and housing events with local partners
• Back-to-school events, including vaccination and immunization awareness events
• Information about community programs, such as Healthy Opportunities (in approved counties only)
• Information about free smoking-cessation programs available to our members

We are excited to collaborate and work together across the state with local nonprofit and county organizations, such as Federally Qualified Health Centers, local health departments, Departments of Social Services, school systems, and housing and employment organizations. Our Wellness & Opportunity Center administrators are actively seeking new program offerings and partnerships.

NC Health Choice to Medicaid: Claims and Billing

• ACNC will follow published NC Health Choice billing guidance for NC Health Choice services rendered before April 1, 2023. New day claims for services rendered on or after April 1, 2023, for former NC Health Choice beneficiaries will be billed per the General Medicaid portion of the Medicaid Billing Guide.

• ACNC will follow existing Claim filing deadlines and payment timelines as outlined in our Claims and Billing manual, found on our website.
  
  
• Existing authorizations will remain with the member record and will not need to be resubmitted, even after the benefit category is changed.

Pharmacy

Updated red Drug List (PDL) Release: April 1, 2023

Mark your calendars: The preferred drug list is updated twice yearly, in April and October. Visit the DHB website in the upcoming weeks for the April 1, 2023, PDL updates.

Resources

Connecting with Your Account Executive (AE)

ACNC has welcomed several new account executives to our team to expand our ability to serve our statewide provider network. To expedite your requests for assistance, we have established dedicated email boxes for specific regions.

Through this new process, you will be connected with a team member within two business days. Please visit the Provider Network Account Executives webpage for details on how to submit your request to ensure we have the information we need to respond. You’ll also see details on how to manage any protected health information (PHI) related to your concern. We look forward to hearing from you.

Provider Total Cost of Care (TCOC) and Quality Enhancement Program (QEP) Manuals Online

AmeriHealth Caritas North Carolina (ACNC) is pleased to announce enhanced incentive programs for selected providers. The Quality Enhancement Programs are reimbursement systems developed for participating practitioners to deliver quality, cost-effective and timely care to our members. These programs suggest opportunities for providers to enhance revenue while providing quality and cost-effective care. Manuals and measures are found on the Provider incentive programs webpage. Training opportunities continue this month, and registration links are found below or on our Provider Training webpage.

The 2023 programs below hyperlink to the manuals and include:

1. Behavioral Health Quality Enhancement Program (BH QEP) (PDF)
2. Perinatal Quality Enhancement Program (PQEP) (PDF)
3. Primary Care Provider Total Cost of Care (PCP TCOC) (PDF)

New or Ongoing Training Opportunities

Join Pinkey Slade, Director of Practice Transformation, the last two weeks in March to learn about the Perinatal and Behavioral Health Quality Enhancement Programs.

Last Chance Training Opportunities

As spring begins, we are updating our training opportunities to better serve you. The titles listed below are the final dates for these offerings, and a few things have changed. Don’t miss out! Click the date to register and receive a Zoom webinar link to the training.