June Provider Digest

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

• 2024 PerformPlus^® True Care — Maternity Care Providers Incentive Program
• Workshops to Support HEDIS and Gap Closure for Well-Child Visits and Child/Adolescent Immunizations
• ACNC to Accept Pharmacy Electronic Prior Authorizations (ePA)

QUALITY CORNER

• Early and Periodic Screening, Diagnostic and Treatment Wellness Visits Do NOT Require Prior Authorization
• Regional Baby Showers

MEMBER BENEFIT SPOTLIGHT

• Members Earn $25 for Completing a Care Needs Screening

REMINDERS

• ACNC Upcoming Pharmacy Changes
• Prior Authorizations
• Remittance Advice Payment Recovery Details Now Available!
• Tobacco-Related Policy Requirements Go into Effect on July 1, 2024

TRAININGS AND FORUMS

• Online Training Course: Take Down Tobacco Youth Advocacy Program
• Tobacco Treatment in Adolescent and Young Adult Populations (8.5 CE hours)
• Registering for and Using NaviNet, Our Provider Portal
• Let’s Work Together: Provider Orientation

2024 PerformPlus^® True Care — Maternity Care Providers Incentive Program

The PerformPlus True Care Programs are reimbursement systems developed for participating providers 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.

Highlights of the Maternity Care program

Within this program, providers will be eligible to receive a $20 payment for each member attributed to their practice, when a claim has been submitted with the appropriate CPT II codes below:

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

Reporting period and settlement timeline

Below is the reporting period and settlement detail for the Maternity Care Providers incentive program:

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

Workshops to Support HEDIS and Gap Closure for Well-Child Visits and Child/Adolescent Immunizations

Is your team struggling to improve 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 workshop series, which will be offered monthly, beginning September 2024. 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. Provider practices may be eligible for financial incentives for improving these HEDIS rates through ACNC Value-Based Programs.

2. Participants who complete all sessions can receive:
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.

ACNC to Accept Pharmacy Electronic Prior Authorizations (ePA)

Effective July 1, 2024, ACNC will accept electronic 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. If you are a NaviNet user, prescribers are encouraged to attend an upcoming Lunch and Learn training series on June 25 or July 9, 2024. 

Additional information can be found on the Pharmacy Prior Authorization webpage before the effective date.

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.

ACNC Upcoming Pharmacy Changes 

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

Prior Authorizations

AmeriHealth Caritas North Carolina (ACNC) continues to make quarterly updates to prior authorization requirements based on guidance from the Centers for Medicare & Medicaid Services (CMS). To coincide, our Prior Authorization Lookup Tool is updated quarterly.

Behavioral Health providers are encouraged to check out our updated Prior Authorization webpage with new Behavioral Health guidance.

Remittance Advice Payment Recovery Details Now Available!

Due to the Change Healthcare security incident, remittance advices generated after February 21, 2024, have not included certain claim recovery information. AmeriHealth Caritas North Carolina (ACNC) is pleased to inform you that a solution has been developed in collaboration with Change Healthcare to provide the detailed payment recovery information missing from the provider remittance advice. This solution will provide payment recovery details on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024.

For claims processed February 21, 2024, through May 5, 2024, ACNC has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your provider internal account number, claim number, provider tax ID, payee/group ID, and NPI.

To access the claims recovery report:

• Log in to the NaviNet provider portal.
• Select applicable health plan.
• Go to Report Inquiry, under Workflows for this Plan.
• Click on Administrative Reports > Claim Recovery Report.

If you do not have access to the NaviNet provider portal, please visit: https://register.navinet.net/ to sign up.

Questions?

For questions, please contact Provider Services at 1-888-738-0004 or your Provider Network Management Account Executive.

We appreciate your partnership and patience as we work to re-establish services and will continue to share additional information as it becomes available.

Tobacco-Related Policy Requirements Go into Effect on July 1, 2024

Tobacco-related policy requirements will be effective July 1, 2024, for NC Medicaid Managed Care Standard Plans, Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans, and Local Management Entity/Managed Care Organizations (LME/MCOs) contracted medical, behavioral health, I/DD and traumatic brain injury (TBI) service providers. Two new items have been added to the policy: a provider monitoring process and additional technical assistance through Breathe Easy, North Carolina.

Find additional information in the March 21, 2024, North Carolina Department of Health and Human Services (NCDHHS) Bulletin.

Online Training Course: Take Down Tobacco Youth Advocacy Program

This free, award-winning, evidence-based program is rooted in experiential learning. It's geared toward middle school and high school students to equip them with skills to create change in their communities and fight for the first tobacco-free generation — but anyone can do it. Register below to learn more:

Register for course

Adapted with permission from NCDHHS Tobacco Prevention and Control Branch.

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 below to learn more:

Register for course

Adapted with permission from NCDHHS Tobacco Prevention and Control Branch.

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 through November. Register below to learn more.

Register for Using NaviNet

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.