February Provider Digest

AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. You will find the following topics in this February digest:

• 2024 PerformPlus^® True Care Program Training Session
• Updated Provider Manual Now Available

QUALITY CORNER

• Behavioral Health Provider Focus: Critical Incident Reporting
• Medical Record Data Request for Select Providers
• Regional Baby Showers

NORTH CAROLINA TOBACCO CESSATION NEWS

• NCDHHS Tobacco-Free Policy Requirement
• New Resource to Support Cessation for American Indian and Alaska Native People
• Center for Rapid Surveillance of Tobacco Launches Products Tracking App

CLAIMS AND BILLING GUIDANCE

• Home Health Electronic Visit Verification Reminder

PHARMACY

• ACNC Upcoming Pharmacy Changes
• Discontinuation of Medications

MEMBER BENEFIT SPOTLIGHT

• How to Link Patients to Healthy Opportunities Pilot Services

TRAININGS AND FORUMS

• Let’s Work Together: Provider Orientation
• Electronic Funds Transfer Enrollment Link
• 2024 Clinical Leadership Forums

2024 PerformPlus^® True Care Program Training Session

Please join our Practice Transformation Director, Pinkey Slade, to learn more about AmeriHealth Caritas North Carolina’s (ACNC) 2024 enhancement programs. The PerformPlus True Care 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. Learn more and see manuals and measures on the Value-Based Programs page on our website. 

The 2024 programs include:

1. Maternity Care Providers
2. Behavioral Health Providers
3. Primary Care Providers
4. Maternity Care Incentive Program
5. Gaps in Care Closure Incentive Program

Please register for the Practice Transformation training date using the registration link below.

Monday, February 26, 2024, at 12:00 p.m.

Updated Provider Manual Now Available

The updated Provider Manual (PDF) is available. Several high-level revisions include:

• Updated member CARE Card rewards
• Reorganized prior authorizations content and submission process for clarity
• Simplified provider grievance and appeals process information
• DHHS Credentialing and Recredentialing updates
• DHHS Tobacco Free Policy information  —  effective April 1, 2024

For your convenience, a revision log is found at the back of the Provider Manual to help identify updates.

Behavioral Health Provider Focus: Critical Incident Reporting

Below are helpful tips for behavioral health providers to maintain compliance with critical incident reporting through the NC Incident Response and Reporting System (NC IRIS):

Level II and III critical incidents must be submitted in NC IRIS within 72 hours of learning of the incident.

• Critical incidents initiated in NC IRIS within the 72-hour required time frame but not submitted within the required time frame are not considered timely.

• Be sure the “Supervisor Actions” section is completed, and submission is confirmed. If submission is confirmed, you will see the thumbs up. If you do not see the thumbs-up graphic along with the incident number after completing the report, the critical incident report has not been submitted. 
  
  
• Save the incident number to update and complete the report when you have the necessary information.

• Exceptions: 
  • Level III reports also require a verbal report to ACNC immediately.
  • The patient’s death within seven days of seclusion or restraint requires an NC IRIS report immediately.

Level III incident reporting:

Complete an Internal Team Review and upload/attach the findings to the critical incident report.

• Death reporting:
  • ACNC is unable to close the critical incident in NC IRIS without official documentation of the cause of death; therefore, behavioral health providers must:
    • Request the Medical Examiner’s Report/Autopsy Report/Toxicology Report from the North Carolina Office of the Chief Medical Examiner (OCME). The document request can be made at https://www.ocme.dhhs.nc.gov/docrequest.asp.
    • If an autopsy was not performed, contact the Register of Deeds Office in the county where the consumer passed away to request the death certificate. (An uncertified copy is sufficient.)
    • Once the supplemental information is received, amend the critical incident report in NC IRIS to reflect the new information, including updating the “Supervisor Actions” section (Cause of Incident/Incident Prevention).

Send questions concerning critical incident reporting to the ACNC Critical Incident email.

Resources:

• IRIS Technical Manual (PDF)
• Incident Response and Reporting Manual (PDF)

Medical Record Data Request for Select Providers

The annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting period is just around the corner, and we need provider cooperation with our efforts to collect medical record data for our members whom you have treated.

AmeriHealth Caritas North Carolina has contracted with ComplexCare Solutions, formerly known as Inovalon, to manage the medical record retrieval for the annual medical record review process. ComplexCare Solutions is required to comply with Health Insurance Portability and Accountability Act (HIPAA) Privacy requirements throughout the retrieval process and is trained in medical record retrieval for HEDIS, Centers for Medicare & Medicaid Services (CMS), and state quality reporting programs.

Disclosure and use of the medical records, and the collection of medical records for this purpose, are considered to be treatment, payment or health care operations in accordance with the HIPAA Privacy Rule (see 45 C.F.R. §164.502 (a)(1)(ii)).

We appreciate your cooperation in working with ComplexCare Solutions to schedule retrieval of any requested member records. Records requested should be provided at no charge to the health plan.

If you have any questions, please reach out to Melissa Lawson, Lead Data Reviewer, at 215-863-6318. We greatly appreciate your cooperation and timely assistance with this medical record request.

Regional Baby Showers

ACNC continues work to improve maternal health outcomes, especially among people of color, by hosting regional community baby showers at our Wellness & Opportunity Centers and partner locations across the state. Our goal is to educate, empower and support women who have recently delivered a baby or who are pregnant, as well as their families.

Our baby showers offer us a chance to celebrate the arrival of new babies and encourage moms to get the prenatal and postpartum care and support they need. Please share these opportunities with your patients and have them register via the event calendar links on the Wellness & Opportunity Centers webpage. ACNC members can get no-cost transportation to any of our sponsored events through our transportation provider, ModivCare. 

If your practice is interested in participating in a baby shower event, please contact our ACNC Quality Management team.

ACNC Upcoming Pharmacy Changes

NEW Pharmacy Prior Authorization Criteria and Form changes can be reviewed on the ACNC Pharmacy webpage. The following are effective March 1, 2024:

• GLP-1 Receptor Agonists and Combinations
• SGLT2 Inhibitors and Combinations

The NC Medicaid Preferred Drug List update will occur April 1, 2024. For assistance with pharmacy prior authorizations or pharmacy claim questions, contact PerformRx Provider Services at 1-866-885-1406. 

Discontinuation of Medications

For complete details, please reference the NC Medicaid Pharmacy Newsletter, December 2023.

Flovent HFA and Flovent Diskus

As of December 31, 2023, GSK has discontinued all strengths of Flovent HFA and Flovent Diskus. The authorized generics, fluticasone propionate HFA (generic for Flovent HFA) and fluticasone propionate diskus (generic for Flovent Diskus), have been added as preferred on the NC Medicaid Preferred Drug List (PDL) effective December 1, 2023.

Flovent HFA/Diskus will remain preferred so that claims will continue to pay until any remaining stock of the brand is depleted.

Levemir

Novo Nordisk has announced the permanent discontinuation of all formulations of Levemir. Supply disruptions of Levemir FlexPen are expected to begin in mid-January 2024, followed by the complete discontinuation of the FlexPen on April 1, 2024. The Levemir vial will be discontinued on December 31, 2024.

Levemir will remain preferred on the Preferred Drug List (PDL) so that claims will continue to pay until any remaining stock is depleted

Please refer to the NC Medicaid PDL for alternative preferred options, such as insulin glargine vial/SoloStar (authorized biologic for Lantus).

How to Link Patients to Healthy Opportunities Pilot Services

Through the Healthy Opportunities Pilot Program (HOP), ACNC can help connect members to resources in the community to help with housing, food, transportation, or personal safety concerns. The HOP Program is offered in select counties only. For more information, visit the Healthy Opportunities Pilot Program webpage. To refer your patient for services, submit a request form.

Let’s Work Together: Provider Orientation

Our provider orientation sessions are presented on the 2nd Tuesday of each month from noon to 1 p.m. ET. Our Account Executives host each Let’s Work Together session, sharing tools and information to support provider success as part of our network. Find the registration link on our Provider Training page.

Electronic Funds Transfer Enrollment Link

ACNC contracts with Change Healthcare and ECHO Health, Inc., to administer electronic funds transfer (EFT) payments and electronic remittance advice (ERA). If your practice has not yet registered for EFT, enroll using this direct ACH enrollment link, where there are no fees for single payer agreements. If you have any questions or are experiencing any problems with payments or registration, please contact our Provider Network Account Executive.

2024 Clinical Leadership Forums

ACNC is pleased to provide opportunities for providers to engage with our team to discuss quality improvement activities and associated challenges, related to quality and population health outcomes. Each lunchtime session includes a Provider Spotlight to highlight best practices, as well as open discussion with participants.

Register for 2024 Forums

Each session is from noon to 1 p.m. ET

Check back often on our Training webpage for the latest educational, forum and self-paced training opportunities. We continue to offer ways for our providers to engage with Quality measures, resources and our teams.