July Provider Digest

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

• Ask the Experts: About Black Maternal Health
• ACNC to Accept Pharmacy Electronic Prior Authorization (ePA) Requests
• Exemption of Copay for Drugs Used to Treat Opioid Use Disorder and Nicotine Replacement Therapy
• DELAY: Tobacco-Related Policy Requirements Go into Effect on July 1, 2025
• Safeguarding Your Practice: Beware of Phishing Scams

QUALITY CORNER

• Prenatal and Postpartum Care (PPC) HEDIS Measure
• Value-Added Benefits to Support Prenatal and Postpartum Care
• Regional Baby Showers

CLAIMS AND BILLING

• Known System Issues Reminder

MEMBER BENEFIT SPOTLIGHT

• Member Rights, Responsibilities and Privacy

TRAININGS AND FORUMS

• Invitation to Improve HEDIS and Gap Closure for Well-Child Visits and Child/Adolescent Immunizations
• Support in Navigating Electronic Visit Verification (EVV)
• Tobacco Treatment in Adolescent and Young Adult Populations (8.5 CE hours)

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

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. 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.

How it works:

There are two options available for creating and submitting electronic prior authorization (ePA) requests. Not only can subscribers submit via Electronic Health Record (EHR), but also electronically to CoverMyMeds and Surescripts. Follow the steps below.

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.

Exemption of Copay for Drugs Used to Treat Opioid Use Disorder and Nicotine Replacement Therapy

Effective August 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 from June 2024.

DELAY: Tobacco-Related Policy Requirements Go into Effect on July 1, 2025

On June 28, 2024, North Carolina Department of Health and Human Services (NCDHHS) announced a delay to the tobacco-related policy requirements. Please see the June 28 blog post for additional information.

Safeguarding Your Practice: Beware of Phishing Scams

One of the biggest information security risks for most organizations occurs when an associate opens a phishing email and clicks on the link. It only takes one associate clicking a phony link to impact an organization’s cybersecurity efforts. Please share this with your team.

Why it’s important

Phishing scams are emails that look real but are designed to steal important information. A phishing email with malicious software can allow cybercriminals to take control of your computer and put protected health information (PHI) and personally identifiable information (PII), as well as a company’s confidential and proprietary information, at risk.

It may be a phishing email if it:

• Promises something of value (e.g., “Win a free gift card.”)
• Asks for money or donations
• Comes from a sender or company you don’t recognize
• Links to a site that is different from that of the company the sender claims to represent
• Comes from a trusted business partner that has experienced a security incident. All emails from outside your organization should be scrutinized.
• Asks you for personal information, such as your username and password/passphrase
• Includes misspelled words in the site’s URL or subject line

If you suspect an email may be phishing, here are some tips:

• Do not click any links in the email.
• Do not provide your username and password; you should never share your username or password, even if you recognize the source. Phishing scams frequently mimic well-known companies, such as retailers (like Amazon) or banks.
• Do not reply or forward the email to anyone within your organization.
• Familiarize yourself with your organization’s process for reporting suspicious emails. If you suspect an email is a phishing attempt, report it immediately.
• Your organization’s information security department may have additional information and guidance on how to protect yourself from phishing scams.

Prenatal and Postpartum Care (PPC) HEDIS Measure

The Prenatal and Postpartum Care (PPC) HEDIS measure is the percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year.¹

Two rates are measured:

• Timeliness of Prenatal Care: The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date, or within 42 days of enrollment in the health plan.
  
  
• Postpartum Care: The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

Best practices to meet the Prenatal and Postpartum (PPC) measure include:

• Schedule the first prenatal visit in the first 12 weeks of pregnancy with an OB/Gyn, PCP, or other prenatal practitioner.² Nurse visits do not count for the measure.
• Remind patients of their appointments via phone calls, emails, or texts.
• Educate patients on the importance of the initial prenatal visit, and the importance of keeping each prenatal and postpartum appointment.
• Utilize CPT Category II codes to capture the date of the first prenatal visit and the postpartum visit.
  • 0500F – Initial prenatal visit
  • 0503F – Postpartum visit

AmeriHealth Caritas North Carolina offers members CARE Card rewards for attending prenatal ($10/visit, up to seven per pregnancy) and postpartum ($15 if completed within 7 – 84 days after delivery) visits. Learn more about CARE Card rewards.

Value-Added Benefits to Support Prenatal and Postpartum Care

As of July 15, ACNC is now offering two new value-added benefits for pregnant and new moms to support 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.

Regional Baby Showers

Our next ACNC Baby Shower will be in Charlotte in August. If you are interested in participating, please send an email to ACNCQualityManagement@amerihealthcaritas.com.

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, or 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).

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.

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.

Support in Navigating Electronic Visit Verification (EVV)

This webinar is an informal Q&A session, specifically for the home health providers that bill taxonomy code 251E00000X. These provides are required to bill with EVV. For a more complete description of services, see NCDHHS Medicaid Clinical Coverage Policy 3A for Home Health Services (PDF).

During our time together, we will provide additional support and education for home health providers to prepare for the state’s reimplantation. A new hard launch date has not been announced. Offered each Wednesday at 5 p.m., these webinars will cover the necessary steps to establish a connection with the vendor, HHaExchange, and cover how to bill claims. Register here for an upcoming session.

Register for webinar

Tobacco Treatment in Adolescent and Young Adult Populations (8.5 CE hours)

This course is designed for both health care and non-health care professionals who work with youth and young adults who would like a deeper and more practical understanding of the problem of tobacco use among young people, and opportunities to prevent and treat tobacco use and its sequelae. Grounded in a developmental framework, the course will explore the neurobiological and neurodevelopmental underpinnings of tobacco use and addiction among youth, the physiological and broader health impacts of use, the current prevalence of use and opportunities for community-based prevention, and essential clinical skills and resources involved in treating tobacco use disorders at the point of care, including behavioral and medication treatments.

Register for course

Adapted with permission from NCDHHS Tobacco Prevention and Control Branch.