September 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 Expansion Will Launch on December 1, 2023
• Pitt County Area Community Baby Shower & Maternity Fair
• It’s Here! ACNC Welcomes Our Mobile Wellness & Opportunity Center
• Provider Manual 2022-2023 Clarification: Sterilizations
• New 2023 Provider Satisfaction Survey

PHARMACY

• Upcoming Preferred Drug List Release

NCDHHS REMINDERS

• Timely Filing Requirement Announcement
• Provider Reverification
• Electronic Visit Verification (EVV) Home Health Implementation October 1, 2023

BENEFITS SPOTLIGHT

• No-cost Non-emergency Transportation for ACNC Members

TRAININGS AND FORUMS

• Change for Life: Tobacco-Free Recovery NC Coalition
• How to Support Clients and Your Organization to Become Tobacco-Free
• Registering for and Using NaviNet, Our Provider Portal
• Provider Orientation Held Monthly
• On-Demand Video Training: Electronic Claims and 275

NC Medicaid Expansion Will Launch on December 1, 2023

Governor Roy Cooper and N.C. Department of Health and Human Services (NCDHHS) Secretary Kody H. Kinsley announced NCDHHS will launch Medicaid Expansion on December 1, 2023, giving more than 600,000 North Carolinians access to health care. On Friday, September 22, Governor Cooper announced he would allow the state budget passed by the NC General Assembly to become law and directed NCDHHS to immediately begin the process to start Medicaid expansion in North Carolina. NCDHHS anticipates approximately 300,000 eligible people currently receiving Medicaid Family Planning benefits will automatically be enrolled in full health care coverage on December 1.

For more details, please see the NC DHHS news release and the Medicaid bulletin.

Pitt County Area Community Baby Shower & Maternity Fair

Our next community baby shower will be held Saturday, Oct. 14, from 11 a.m. to 1 p.m. at our Greenville Wellness & Opportunity Center, located at 1876 West Arlington Blvd. in Greenville.

The event is open to any new or expectant moms, and we encourage our providers to help spread the word! We’ll have local vendors and providers with education and resources, free baby supplies, games, and lunch, all at no cost. 

It’s Here! ACNC Welcomes Our Mobile Wellness & Opportunity Center

Our Mobile Wellness & Opportunity Center has been traveling the highways and byways of North Carolina since its arrival in late July, partnering with providers and community partners to host health screenings, immunization clinics, and educational programs. The bus will primarily serve the greater Raleigh/Durham area (Medicaid Region 4) but is available for member and community-facing events around the state. If you would like to learn more, contact your Provider Network Account Executive for partnership opportunities.

Visit our community webpage and look for Wellness & Opportunity Centers to find links to event calendars for all our centers.

Provider Manual 2022-2023 Clarification: Sterilizations

In response to questions about inconsistencies on requirements for sterilization procedures on page 91 of the 2022 Provider Manual, please see the following update. This modification will be incorporated into the 2023 version of the manual, pending state approval.

Sterilizations

The rendering provider (surgeon) no longer needs to submit the appropriate consent form at the same time as the claim submission for these services. The new process is as follows:

• Sterilizations are not covered for members less than 21 years of age. The rendering provider (surgeon) must submit the appropriate consent form for these services. Consent forms in English and Spanish are included in the NCDHHS Clinical Coverage policy on Sterilization Procedures on the NCDHHS website under Obstetrics & Gynecology.
  
  
• A member seeking sterilization must voluntarily give informed consent on the appropriate consent form. The member must give informed consent not less than 30 full consecutive days (or not less than 72 hours in the case of emergency abdominal surgery) but not more than 180 calendar days before the date of the sterilization. In the case of premature delivery, informed consent must have been given at least 30 days before the expected date of delivery. A new consent form is required if 180 days have passed before the sterilization procedure is provided.

NCDHHS’s Sterilization Consent Form was updated February 14, 2023. The form must be completed correctly in accordance with the instructions. The claim and consent forms will be retained by ACNC.

New 2023 Provider Satisfaction Survey

We want to hear from you! This fall, we’ll be 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:

1. Online, using the credentials given in the letter by going to www.pressganey.com
2. 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.

PHARMACY

Preferred Drug List Release: October 1, 2023

The next North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL) updates will be effective on October 1, 2023. Visit the ACNC Pharmacy website on or after October 1^st to download the updated PDL.

NCDHHS REMINDERS

Timely Filing Requirement Announcement

North Carolina 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.

Provider Reverification

Recredentialing/reverification is an evaluation of a provider’s ongoing eligibility for continued participation in NC Medicaid. The Affordable Care Act mandates that providers be recredentialed every five years. NC Medicaid notifies providers of their recredentialing due date via the message center inbox in the NCTracks secure provider portal.

Providers who do not complete the recredentialing process on time will be suspended from Medicaid program participation. The provider will be terminated from the NC Medicaid program following 50 days of suspension. For convenience, NC Medicaid has posted a list of providers up for recredentialing at “Active Provider Re-Verification Due – July 2023 – Dec 2023 [medicaid.ncdhhs.gov]” (updated biannually).

Providers are encouraged to review the list and check your Provider Message Inbox in the NCTracks Secure Portal for notifications. For more information, visit NC Tracks (the reverification section of the Status and Management page) for the option to reverify. Find more information on the NCDHHS website or contact the NCTracks Call Center at 1-800-688-6696 for assistance.

Electronic Visit Verification (EVV) Home Health Implementation

Providers are encouraged to review the NCDHHS Blog article from September 18, 2023 regarding the hard launch effective, October 1, 2023. Claims without the required EVV data will be denied.

MEMBER BENEFITS SPOTLIGHT

No-cost Non-emergency Transportation for ACNC Members

ACNC provides its members with non-emergency transportation (NEMT) to and from medical appointments at no cost to the member. The benefit can include transportation using:

• Public transit – bus or rail
• Sedan, van, or taxi
• Wheelchair-accessible van vehicle
• Non-emergency ambulance
• Mileage reimbursement for members who drive themselves

Ride requests should be made up to two days in advance, directly through ModivCare, Monday through Saturday. One-way trips cannot exceed 75 miles. Members who have transportation or drive themselves to appointments can receive mileage reimbursement at the current IRS rate which is 65.5 cents per mile. Those seeking reimbursement must complete a paper form or through the ModivCare app, available for smartphones. The Modivcare App makes it easy to book a ride, or record mileage and apply for reimbursement. The app can be downloaded from Google Play or the Apple App Store.

As an added value benefit, ACNC offers transportation support for members to attend programs at any of our Wellness & Opportunity Centers.

TRAINING AND FORUMS

Change for Life: Tobacco-Free Recovery NC Coalition

Change for Life: Tobacco-Free Recovery NC Coalition* is asking for your engagement in a virtual forum. What REALLY happens when an agency goes tobacco-free? Find out at the virtual Change for Life: Tobacco-Free Recovery NC launch meeting. Engage with peer organizations that became tobacco-free or are working toward it!

You may be wondering:

• How will my clients/staff respond to a tobacco-free policy?
• What are the benefits of going tobacco-free?
• What helps clients/staff quit or reduce tobacco use?
• How can I offer person-centered tobacco use treatment?

Behavioral health or health professionals will:

• Engage in peer-to-peer sharing and mentoring.
• Access tobacco health experts and training on best practices.
• Share messaging that supports a positive tobacco-free culture of care.
• Learn how to compassionately implement a tobacco-free environment.

The journey begins September 28, 2023, 8:30 – 9:30 a.m. Register Here.

*CHANGE FOR LIFE: TOBACCO-FREE RECOVERY NC is a coalition of behavioral health, health care & disability service organizations working to implement a best-practice tobacco-free culture of care. It is part of the Breathe Easy NC initiative.

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

Oct. 6, 9:30 a.m. – 1 p.m. 3 CEUs approved by NCASPPB

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. Register here for October.

Event Details: This presentation introduces the current standard of care for tobacco use treatment (including information about e-cigarettes and emerging products), including information about counseling and medications. Participants will also learn about community resources, including QuitlineNC, that can help patients or clients quit. Participants will come away with a comprehensive framework to address all forms of tobacco use at a systems level, including e-cigarette use, with their policy and treatment integration process. This includes a focus on working with clients with co-occurring substance use disorders.

Registering for and Using NaviNet, Our Provider Portal

Are you a health care provider or clearinghouse looking to save time and move away from paper prior authorizations? If you’ve signed up for the NaviNet 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 the NaviNet provider portal 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 through November. Register to learn more.

Provider Orientation Held Monthly

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.