October Provider Digest
AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. You will find the following topics in this October digest:
- NC Medicaid Expansion Policy Flexibilities Announced
- Flu Shot Reward for Infants/Toddlers
- No Co-Pay Required for Adult Vaccine Administration
- Care Gap Closure Documentation Reminder
- 2023 Provider Satisfaction Survey
- Timely Filing Requirement Announcement
BENEFITS SPOTLIGHT
TRAININGS AND FORUMS
- Childhood Health and Wellness Clinical Leadership Forum
- Registering for and Using NaviNet, Our Provider Portal
- Provider Orientation Held Monthly
- On-Demand Video Training: Electronic Claims and 275
NC Medicaid Expansion Policy Flexibilities Announced
In preparation for the December 1 launch of Medicaid Expansion, North Carolina Department of Health and Human Services (NCDHHS) has announced policy flexibilities to ease beneficiary confusion and administrative burden on providers. NCDHHS may opt to extend any of these flexibilities after the designated time frame, based on plan operations, to ensure the stability of Medicaid operations for Expansion beneficiaries. Review the September 25, 2023 NCDHHS bulletin and Frequently Asked Questions for more information. Material in the chart below is subject to change based on NCDHHS guidance.
| Policy Lever | Duration | Time frame | Additional details |
|---|---|---|---|
|
Honor existing NC Medicaid medical prior authorizations (PAs) |
182 days |
12/1/23 – 5/31/24 |
This only applies to medical health services (physical health, behavioral health and intellectual/developmental disability [I/DD] services), not pharmacy. |
|
Honor existing NC Medicaid pharmacy PAs |
182 days (or the life of the PA) |
12/1/23 – 5/31/24 |
|
|
Allow expedited PA requests/review for new Expansion members |
182 days |
12/1/23 – 5/31/24 |
This only applies to medical health services (physical health, behavioral health and I/DD services), not pharmacy. |
|
Non-par providers paid at par rates |
182 days |
12/1/23 – 5/31/24 |
This applies to all Medical (physical, behavioral health and I/DD services) providers and pharmacy providers. |
|
Non-par providers follow in-network PA rules |
91 additional days |
6/1/24 – 8/31/24 |
This applies to all medical (physical health, behavioral health and I/DD services) providers and pharmacy providers. |
|
Ability to switch PCP without cause for all members |
274 days |
12/1/23 – 8/31/2024 |
Not limited to Expansion members. Applies to all members. |
Flu Shot Reward for Infants/Toddlers
According to the Centers for Disease Control and Prevention (CDC), children younger than 5 years old, especially those younger than 2, are at higher risk of developing potentially serious flu complications.1
To help encourage vaccination in young children, ACNC is offering a $50 CARE Card reward for children ages 2 and younger who receive a flu shot. The reward is limited to one per child per year and applies for a single dose. Some children may need two doses of flu vaccine to be considered fully protected. The ACNC reward is intended to support our members and providers in improving childhood immunization rates.
No Co-Pay Required for Adult Vaccine Administration
Effective Oct. 1, 2023, copays will no longer be required for adult vaccines and vaccine administration. On June 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released guidance on mandatory coverage requirements for adult vaccines. As part of this guidance based on statutory amendments made by section 11405 of the Inflation Reduction Act (IRA), the Advisory Committee on Immunization Practices (ACIP) recommended adult vaccines and their administration are to be provided without cost sharing.
Care Gap Closure Documentation Reminder
- Providers are encouraged to have all Care Gap Closure form documentation uploaded via NaviNet by Thursday, December 14, 2023.
- Prospective year-round medical record collection efforts for hybrid measures end on December 16, 2023.
- Prospective year-round medical record collection efforts for administrative measures end on January 20, 2024.
Find information and resources on care gap closure and other tools for quality outcomes on NaviNet, our provider portal.
2023 Provider Satisfaction Survey
We want to hear from you! This fall, we are reaching out to a sample of our provider practices with a satisfaction survey to help us gain insight into how we are doing. The survey will take about 15 minutes to complete. Results from the survey will be used to guide administrative and operational changes to our health plan and point out areas that might need improvement.
If you receive the welcome letter and survey in the mail, there are two ways to complete the survey:
- Online, using the credentials given in the letter by going to www.pressganey.com.
- Complete the enclosed survey and return it using the prepaid envelope.
Thank you for your continued partnership with ACNC in the service of our members and for your critical role in providing and coordinating care for them.
Timely Filing Requirement Announcement
NC Medicaid has announced a change in the timely filing requirement from 180 days to 365 days to reduce claim denials. Please see the NCDHHS blog post from May 22, 2023, Provider Payment and Claims Submission Fact Sheets, for more specifics on the change. The timely filing change is for dates of service on or after July 1, 2023, and applies to the original claim submission, any corrected claims and retroactive enrollees.
BENEFITS SPOTLIGHT
Member CARE Card Rewards Program
Members can begin earning rewards in a few ways. Complete the new member Care Needs Screening within 90 days of enrollment with ACNC or via one of the many other recommended health screenings or tests at any time. Information is provided to members in their welcome kit. Rewards earned in a fiscal year (July 1 – June 30) cannot exceed $75.
CARE Card Rewards can be spent at several participating retailers, including Walmart, Food Lion, Walgreens, CVS Pharmacy, Dollar General and Family Dollar. Eligible products are found along with additional information on our CARE Card Rewards Program webpage.
TRAINING AND FORUMS
Childhood Health and Wellness Clinical Leadership Forum
ACNC is pleased to provide an opportunity for providers to engage with our team to exchange best practices related to quality and population health outcomes. We invite you to join us for a Zoom webinar on Wednesday, December 13, 2023, from Noon to 1:00 p.m.
Topics include:
- Quality Measures Overview
- Care Gap Closure Efforts
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Resources
- Primary Care Physician Quality Enhancement Program (PCP QEP) Resources
- Best Practice Spotlight
- Round of Q&A
Registering for and Using NaviNet, Our Provider Portal
Are you a provider or clearinghouse looking to save time and move away from paper prior authorizations? If you’ve signed up for NaviNet, the 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 NaviNet 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 from July to November. Register below to learn more.
| Registering for and Using NaviNet |
1 – 2 p.m. |
|---|
Provider Orientation Held Monthly
| Provider Orientation: Let’s Work Together |
Noon – 1 p.m. |
|---|
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.