May Provider Digest

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

You will find the following topics in this digest:

• Electronic Visit Verification Mandatory for Home Health Services Providers on July 1
• NC Medicaid Temporary Emergency Flexibilities Ending
• Electronic Funds Transfer Through Change Healthcare Is FREE
• June 14, 2023, Women's Health and Wellness Clinical Leadership Forum

RESOURCES

• Provider Manual 2022 Clarifications

TRAINING

• New and Ongoing Training Opportunities

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

Beginning July 1, claims submitted by home health care services (HHCS) providers for selected HHCS services that do not include EVV criteria will be denied. Per guidance from the NC Department of Health and Human 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.

NC Medicaid Temporary Emergency Flexibilities Ending

Beginning with date of service May 12, 2023, NC Medicaid will end the temporary emergency flexibilities implemented for the disposition of three claims processing edits. The affected edits can be found in the Medicaid Provider Reverification and Billing Modifications Reminder bulletin.

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.

June 14, 2023, Women's Health and Wellness Clinical Leadership Forum

ACNC hosts quarterly clinical leadership forums to give providers the opportunity to engage with our clinical and behavioral health leaders to discuss quality improvement activities, associated challenges, and best practices related to quality and population health outcomes. Our June forum will be held on June 14 from noon to 1 p.m. and will focus on Women's Health and Wellness and will cover the following:

• Prenatal and Postpartum Care
• Screening for Cervical Cancer, Breast Cancer, and Chlamydia
• Bright Start^® Maternity Care Program
• Prenatal Quality Enhancement Program (PQEP) and Resources
• Best Practice Spotlight featuring a network provider

Register here for the Women's Health and Wellness Clinical Leadership Forum. 

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 refer to the updated Prior Authorizations web page for 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

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.

In June, we will 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 how to handle ACNC prior authorizations online.