August Provider Digest

AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. A Known System Issues Tracker is updated weekly and also available in NaviNet to providers. You will find the following topics in this August digest:

• Value-Added Benefits to Support Prenatal and Postpartum Care
• Invitation to Improve HEDIS and Gap Closure for Well-Child Visits and Child/Adolescent Immunizations
• Register for Ask the Experts: About Black Maternal Health
• Enroll Now in AmeriHealth Caritas Next

QUALITY CORNER

• Prenatal and Postpartum Care F Codes

CLAIMS AND BILLING

• New NaviNet Functionality to Support Request for Information
• Reminder: Manual/Direct Entry Claims Submission Through PCH Global Is NO Cost to Providers
• Avoid Denials When Completing Sterilization and Hysterectomy Consent Forms

MEDICATION AND PHARMACY

• No More Copay for Drugs Used to Treat Opioid Use Disorder and Nicotine Replacement Therapy
• ACNC Now Accepting Electronic Pharmacy Prior Authorization (ePA) Requests

MEMBER BENEFIT SPOTLIGHT

• Member Rights, Responsibilities and Privacy
• Offering Culturally and Linguistically Appropriate Services (CLAS)
• New Regional Baby Shower Dates Announced

TRAININGS AND FORUMS

• 2024 Clinical Leadership Forums
• Support in Navigating Electronic Visit Verification (EVV)
• Registering for and Using NaviNet, Our Provider Portal
• Facilitators: Mindfulness Training for Smokers
• Virtual Tobacco Cessation Program Implementation Training

Value-Added Benefits to Support Prenatal and Postpartum Care

Effective July 15, ACNC is offering two new value-added benefits for pregnant and new moms to support prenatal and postpartum care (PPC) measures and ensure healthy pregnancies and healthy babies. These benefits are offered at no cost to our members. Please contact your Account Executive with questions.

Prenatal visits: ACNC will send a free infant car seat to a member who has completed at least one prenatal visit in their first trimester. To earn the reward, providers will need to attest to the date of the visit and request a car seat using our Let Us Know: Member Intervention Request form (PDF), located on our website under Provider Manuals, Policies and Forms. The fillable form must be completed and faxed to the Rapid Response and Outreach Team at 1-833-816-2262. Once the form has been received, the car seat will be mailed to the member’s address indicated on the form.

Postpartum visit: ACNC will send a box of diapers and a box of baby wipes to a member who has completed their postpartum visit within the recommended time frame (on or between 7 and 84 days after delivery). This reward will be generated once the claim is received for the postpartum visit. Items will be mailed to the member’s address on record.

Please help us by encouraging your patients to be sure their address information is up to date with their local Department of Social Services, so that our records are as up to date as possible. Information can easily be updated electronically through E-PASS. Find out more here.

Invitation to Improve HEDIS and Gap Closure for Well-Child Visits and Child/Adolescent Immunizations

Is your team interested in improving HEDIS and gap closure for well-child visits and child/adolescent immunizations? If so, then the upcoming ACNC Quality ECHO Clinic is just what the doctor ordered! Spots are limited for this free six-part training series, which will be offered monthly, beginning September 26, 2024. Participating providers will review data as a group and learn best practices for success.

Participating providers will review data as a group and learn best practices for success. Interest sessions begin in July and will explain requirements for participation and share official registration information.

1. Providers may be eligible for incentives for improving these HEDIS rates via ACNC Value-Based Programs.
2. Participants who complete all sessions can receive:

1. 1. 25 Maintenance of Certification Part 4 (MOC4) credits
   2. Continuing medical education (CME) for physicians
   3. Continuing education units (CEU) for nurses

3. Enrollment is limited to six to eight practices; however, a practice can send as many team members to the full series as needed.
4. Check out the Featured Training Schedule found on our Provider Training webpage for additional information.

Please email projectecho@amerihealthcaritas.com for both a flyer on the training series and information on how to attend an upcoming interest session. Interest sessions begin in July and will explain requirements for participation and share official registration information.

Register for Ask the Experts: About Black Maternal Health

Tuesday, September 17, 2024, 7:30 p.m. to 8:30 p.m.
ACNC is hosting a panel discussion for members, community partners and providers about the unique challenges Black women face during pregnancy, delivery and the postpartum period. The panel will be moderated by Nerissa Price, MD, ACNC’s Behavioral Health Medical Director, and will feature an interactive discussion, with our panel of care providers responding to questions from members and other participants. Flyers are available to post in your office or share with patients. Providers are welcome! Find more information and register.

Register for panel.

Enroll Now in AmeriHealth Caritas Next

We are inviting providers in our Medicaid network to join the AmeriHealth Caritas Next health plan network.

AmeriHealth Caritas aims to continue to be there for your patients and our members, offering continuity of care and services as they transition out of Medicaid and can gain coverage through the Health Insurance Marketplace. AmeriHealth Caritas Next is an affordable health insurance option for those who otherwise would have no access to health insurance coverage through their employer, Medicaid, or Medicare. AmeriHealth Caritas Next has been available since 2022 in selected counties (see coverage map here) and is expanding its footprint this fall to include Alamance, Caswell, Person, and Vance counties.

How to join:

• Providers operating under an existing ACNC Medicaid plan or new providers who would like to participate in the AmeriHealth Caritas Next network simply complete a Provider Contract Inquiry Form (PDF) asking to join the AmeriHealth Caritas Next network.
• As part of the contracting process, providers will need to complete credentialing to participate in the AmeriHealth Caritas Next network. Contact your Account Executive for more information on credentialing.
• Submit this form by email to: ProviderRecruitmentNext@amerihealthcaritas.com

Prenatal and Postpartum Care F Codes

NC Medicaid’s Obstetrical Services Clinical Coverage Policy No: 1E-5, updated June 15, 2024, requires the use of two new CPT billing codes for prenatal and postpartum care. These codes will assist in capturing information about the timeliness of prenatal and postpartum care provided to NC Medicaid members. NC Medicaid’s PPC F Codes Fact Sheet (PDF) and FAQ document (PDF) aims to give providers and practices more information about these new F codes, why they are important, and how they should be used. ACNC will implement a warn edit in the coming months for claims that will be denied beginning 7/1/2025 to help providers identify changes for EMR systems and billing practices.

Maternity Provider Incentive

Effective January 1 2024, ACNC providers are eligible for the AmeriHealth Caritas North Carolina Maternity Incentive Program (PDF). Participating providers are eligible to receive a $20 incentive payment for each member attributed to their practice when a claim is submitted with the appropriate CPT II code.

• Timeliness of prenatal care: CPT II code 0500F – Initial Prenatal Care Visit
• Postpartum care: CPT II code 0503F – Postpartum Care Visit

If you have any questions regarding this program, please contact your Provider Network Account Executive.

New NaviNet Functionality to Support Request for Information

ACNC and NaviNet have released new functionality that allows a new document to be sent from ACNC to providers using NaviNet. This new “Pended Claim” document will be sent when additional information is needed to process a submitted claim.

This document will contain patient demographic information, the facility or practice name, dates of service, and the reason the claim is pending. It will direct providers on next steps, including the option to send supporting documents directly via the portal.

Acceptable documentation formats are PDF, TIFF, JPEG, JPG, PNG, DOCX, RTF, XML, DOC, CSV, XLS, XLSX and TXT.

Attend a monthly training Registering for and Using NaviNet to learn how to use the functionality.

Reminder: Manual/Direct Entry Claims Submission Through PCH Global Is NO Cost to Providers

As Change Healthcare continues to address their network interruption related to a security incident, AmeriHealth Caritas North Carolina provides several options for providers to submit claims for timely processing. Providers that submit direct entry claims may do so through PCH Global at no charge.

To enroll for FREE claims submission through PCH Global, please click the Sign-Up link in the upper right-hand corner to register.

1. Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth.
2. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information.
3. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI.
4. When you are ready to submit claims, use the following information to search for our payer information:

• Payer name: AmeriHealth - AmeriHealth Medical Management - North Carolina
• P.O. Box: 7380

For a detailed walk through of the registration process, refer to the PCH Global Registration Manual, found on the PCH Global website in the Resource Menu.

Avoid Denials when Completing Sterilization and Hysterectomy Consent Forms

Providers performing sterilization and hysterectomy procedures must complete the NCDHHS Sterilization Consent and Hysterectomy Statement forms as directed in the Instructions for Federal Sterilization Consent forms (PDF) that are found on the NC Tracks website.¹ Note that hospital forms cannot be used in place of the state forms. English and Spanish forms are located on the NCDHHS website under Reproductive Health Forms. The direct link also can be found on the ACNC website off our Provider Manuals, Policies and Forms webpage.

To support providers in timely and accurate submission of documentation for sterilization and hysterectomy procedures, ACNC has developed the following checklists:

For sterilization procedures:

• Obtain patient signatures at least 30 days prior to the procedure, per NCDHHS guidelines. The only exceptions are emergency cases due to premature delivery or emergency abdominal surgery.
• If the procedure is being done due to premature delivery, emergency abdominal surgery or ectopic pregnancy, include information at the bottom of the physician’s statement section of the form.
• Ensure the Statement of Person Obtaining Consent and/or Physician Statement sections of the form include the type of operation.
• Be sure that all physician signatures have dates included.

For hysterectomy procedures:

• Include the diagnosis code and/or clinical information to support the claim.
• If the procedure is being done due to an emergency, include the date in the last section, at the very bottom of the page.
• Be sure that all physician signatures have dates included.

Providers may submit the forms after the procedure is performed, but prior to claim submission to confirm the validity of the paperwork. Submission may be done by fax to 1-833-893-2262. You can check on the status of the form through the NaviNet portal or request a response via fax.

Forms must be received by ACNC prior to or at the same time as the claim. If a claim is received for which there is no accompanying state-approved form, the claim will be pended for 90 days and the provider will be notified via postal mail with a Request for Additional Information (RFAI). The RFAI document, along with the required form, should be faxed to ACNC at 1-833-893-2262 within 90 days of the date of the letter. To check on the status of a pended claim, please go to the Provider Portal, NaviNet or call Provider Services at 1-888-738-0004 and reference the Claim Number found on the RFAI.

No More Copays for Drugs Used to Treat Opioid Use Disorder and Nicotine Replacement Therapy¹

“Effective Aug. 1, 2024, North Carolina Medicaid is removing copayment requirements for opioid antagonists, nicotine replacement therapy, and medications used to treat opioid use disorder. This change applies to both NC Medicaid Direct and NC Medicaid Managed Care beneficiaries who are covered under the Outpatient Pharmacy benefit. This exemption supports public health efforts to increase access to substance use disorder treatment.

“The exemption helps to ensure beneficiaries living with nicotine dependence or opioid use disorder (including emergency treatment of known or suspected opioid overdose) do not face financial barriers when obtaining these medications from outpatient pharmacies.”

For further information see The North Carolina Medicaid Pharmacy Newsletter (PDF) from June 2024.

ACNC Now Accepting Electronic Pharmacy Prior Authorization (ePA) Requests

On July 1, 2024, ACNC began accepting electronic pharmacy prior authorization (ePA) requests through PerformRx^SM via CoverMyMeds and Surescripts. This new option is in addition to EHR submissions. ePA can eliminate the need for fax or phone submissions and offers a more streamlined prior authorization process. With the ability to automatically identify and quickly process pharmacy prior authorizations at the point of care, you can improve your practice’s efficiency, avoid post-visit disruptions, and deliver a more satisfying patient experience. Additional information is available on the Pharmacy Prior Authorization webpage.

1. EHR Submissions

Before a prescription is sent to the pharmacy:

During the prescribing process, you’re alerted if a prior authorization is required:

1. You’ll receive a question set electronically from PerformRx.
2. Complete the question set and submit it to PerformRx for review.
3. Once the review is completed, you’ll receive a status notification. If approved, you’ll notify the pharmacy that the prescription can be processed.

If the prescription has been processed and rejected at the pharmacy:

1. You’re notified by the pharmacy that the medication requires prior authorization.
2. Take action within your EHR to initiate the prior authorization request.
3. Repeat steps 1 – 3 above to submit for review.

2. CoverMyMeds and Surescripts Provider Portal Submissions

Care teams can access a secure Provider Portal made available through the CoverMyMeds or Surescripts websites. This avoids the need to set up and use an EHR tool, but the electronic prior authorization request submission remains the same through the Provider Portal.

Access the Provider Portal options via these links:

• CoverMyMeds
• Surescripts

If you have questions regarding a prior authorization request submitted for AmeriHealth Caritas North Carolina, call Pharmacy Provider Services at 1-866-885-1406.

Member Rights, Responsibilities and Privacy

As a reminder, ACNC, our network providers, and other service providers may not discriminate against members based on race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex, gender identity or expression, sexual orientation or any other basis prohibited by law. Please review the Member Rights, Responsibilities and Privacy section on our website or found on page 50 of the AmeriHealth Caritas North Carolina Member Handbook (PDF).

Offering Culturally and Linguistically Appropriate Services (CLAS)

Linguistic barriers, race, disability, sexual orientation and gender, health literacy, and other factors influence how patients perceive symptoms and health conditions, when they seek care, their expectations of care, preferences regarding treatment, willingness to follow their provider’s treatment plan, and whom they include in making their health care decisions. Therefore, it is imperative that health care organizations and providers understand and deliver care that is centered around Culturally and Linguistically Appropriate Services (CLAS), as detailed by the Office of Minority Health (OMH). More information about CLAS and the National CLAS Standards can be found on our cultural competency training webpage.

Keep these language assistance expectations in mind when supporting our members.

• Providers are expected to offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to the individual, to facilitate timely access to all health care and services.
• Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
• Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
• Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

New Regional Baby Shower Dates Announced

Facilitators: Mindfulness Training for Smokers

Learn more or register:

Duke-UNC Tobacco Treatment Specialist Training Programs

Earning 9.25 CE credit hours, learn how to teach the Mindfulness Training for Smokers curriculum and help your patients become tobacco free. This NEW training course will provide the foundation you need to facilitate the Mindfulness Training for Smokers intervention in your own practice setting. Using experiential methods, you will gain insights into the principles of mindfulness and learn how to apply them effectively to manage the unique challenges that smokers face during their journey to quit. (Reprinted with permission from Stephanie Gans from NCDHHS.)

Virtual Tobacco Cessation Program Implementation Training

Learn more or register:

Duke-UNC Tobacco Treatment Specialist Training Programs

In this interactive session, participants will learn to identify key steps in establishing or enhancing a tobacco cessation service in their practice area. This will be presented alongside real-world examples from Duke Health and the NC Tobacco Prevention and Control Branch. (Reprinted with permission from Stephanie Gans from NCDHHS.)