September 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 September digest:

QUALITY CORNER

CLAIMS AND BILLING

MEDICATION AND PHARMACY

    MEMBER BENEFIT SPOTLIGHT

      TRAININGS AND FORUMS

      Updated Provider Manual Now Available

      The updated Provider Manual (PDF) is available. For your convenience, a revision log is found at the back of the appendix to help identify updates.

      2024/2025 Season Alert: Respiratory Syncytial Virus (RSV) and Vaccination Information

      The North Carolina Department of Public Health (NC DPH) set an RSV season start date of September 15, 2024. A new vaccine recommended for older adults was announced, and codes have been added to the Healthcare Common Procedure Coding System (HCPCS) and the National Drug Code (NDC) Rebate Bypass lists.

      The RSV vaccine is indicated for active immunizations for the prevention of lower respiratory tract disease (LRTD) caused by RSV and is recommended for pregnant people for 32 – 36 weeks gestation, using seasonal administration, to prevent RSV lower respiratory tract infections in infants.

      Please see the latest NCDHHS bulletin dated January 24, 2024, for more information.

      2024 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 SPHSurvey.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.

      Members Are Sharing Post-Appointment Feedback with Providers

      During the first six months of 2024, 82 percent of ACNC members surveyed were satisfied overall with their most recent provider visit. The Post-Appointment Member Satisfaction Survey is a five-question survey sent randomly via text message to members following an appointment with their provider. The responses are on a scale of “Very Dissatisfied to Very Satisfied” for six questions. Below are response highlights from January – June 2024.

      Satisfaction by Question

      Post-Appointment Member Satisfaction Survey

      Providers can view their member satisfaction ratings through a new Post-Appointment Survey Provider Scorecard, available in the NaviNet provider portal. To access this new feature, log in to NaviNet, and navigate to Clinical Reports Inquiry > Report Selection > Post-Appointment Survey Provider Scorecard.

      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
      QUALITY CORNER

      Strategies to Increase Influenza Vaccinations

      It’s time to prepare for flu season!

      The Centers for Disease Control and Prevention (CDC) recommends routine annual influenza vaccinations for all people ages 6 months or older who do not have contraindications.1 

      Your strong recommendation that your patients get the influenza vaccine is one of the most important factors in patients accepting the vaccine.2 The SHARE method is a best practice to help increase vaccination rates.

      SHARE “why an influenza vaccine is right for the patient given” their “age, health status, lifestyle, occupation, or other risk factors.”
      HIGHLIGHT “positive experiences with influenza vaccines…to reinforce the benefits and strengthen confidence in influenza vaccination.”
      ADDRESS “patient questions and…concerns about influenza vaccines, including side effects, safety, and vaccine effectiveness in plain and understandable language.”
      REMIND “patients that influenza vaccines help protect them and their loved ones from serious influenza illness and complications that can result in hospitalization and even death.”
      EXPLAIN “the potential costs of getting influenza, including potential serious health effects for the patient, time lost…financial costs, and potentially spreading influenza to more vulnerable family and friends.”3
      Other best practices to consider for scheduling influenza vaccines in your practice:
      • Advertise the influenza vaccine as soon as it’s available.
      • Have visits for influenza vaccines that can be completed by nurse or staff only by standing orders in the practice, or complete block scheduling for immunization-only visits that are scheduled with a provider.
      • Consider offering after-hours appointments or Saturday influenza vaccine clinic days.
      • Offer the vaccine to siblings, parents/guardians, and caregivers of patients in all practice type settings.4
      Resources for providers for influenza season:

      1“Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season,” Recommendations and Reports, Vol. 72, No. 2, August 25, 2023

      2“HCP Fight Flu Toolkit,” Centers for Disease Control and Prevention, March 22, 2024

      3Prepare Your Practice flu season deck (PPT), Centers for Disease Control and Prevention, September 2022

      4“Best Practices for Scheduling Influenza Vaccines in Your Practice,” American Academy for Pediatrics, August 29, 2023

      Regional Baby Showers

      Region 2 Baby Shower Greensboro Wellness & Opportunity Center Saturday, October 12, 2024
      11:30 a.m. – 1:30 p.m.

      Visit our community webpage for links to all our Wellness & Opportunity Center event calendars.

      If your practice is interested in participating in a baby shower event, please send an email to ACNCQualityManagement@amerihealthcaritas.com.
      CLAIMS AND BILLING

      Electronic 275 Document Submission — New Availity Functionality

      ACNC is accepting ANSI 5010 ASC X12 275 claim attachments (unsolicited) via the Availity Intelligent Gateway. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 attachment submissions via payer ID: 81671. See our Claims and Billing webpage for more information.

      How to Find a Claims Recovery Report

      As of May 6, 2024, a remittance advice (or ERA/835) for each transaction is included with your payments. For the period February 21, 2024, through May 5, 2024, providers who are in NaviNet can obtain a comprehensive claim processed report by following the steps below.

      To access the claims recovery report:

      1. Log in to the NaviNet provider portal.

      2. Select applicable health plan.

      3. Go to Report Inquiry under Workflows for this Plan.

      4. Click on Administrative Reports > Claim Recovery Report.

      If you are not a NaviNet user and would like to obtain information from the period February 21, 2024, through May 5, 2024, please contact your Provider Network Account Executive. To learn more and sign up for NaviNet, review the dedicated webpage.

      Provider Claims Inquiries

      Providers may file an inquiry about claims no later than 365 days from the date of service or 60 calendar days after the payment, denial, or recoupment of a timely claim submission, whichever is latest. Inquiries are questions from providers regarding how a claim was processed. Inquiries can be submitted via phone, online or written correspondence. An inquiry may or may not result in a change in the payment.

      If a provider does not receive payment for a claim within 45 days or has concerns regarding any claim issue, claims status information is available by:

      • Visiting the NaviNet provider website, our secure provider portal to log on for web-based solutions for electronic transactions and information.
      • Opening a claims investigation via NaviNet with the claims adjustment inquiry function.
      • Requesting an inquiry on grievance or appeals status via NaviNet by providing the document or service form ID.
      • Calling Provider Services at 1-888-738-0004 and following the prompts.
      • Calling your Account Executive for assistance.

      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.

      If you are not already registered for NaviNet, attend a monthly training Registering for and Using NaviNet to learn how to use the functionality and much more.

      MEDICATION AND PHARMACY

      NC Medicaid Adds Coverage for Obesity Management Medications

      Effective Aug. 1, 2024, NC Medicaid added coverage for U.S. Food & Drug Administration (FDA)-approved obesity management medications for beneficiaries 12 years of age and older. Covered medications include drugs from manufacturers enrolled in the Medicaid Drug Rebate Program that are covered for the FDA-approved indication of treating obesity, when the beneficiary meets the required prior authorization criteria. This additional coverage applies to both NC Medicaid Direct and NC Medicaid Managed Care beneficiaries covered under the Outpatient Pharmacy benefit.

      For more details, please see The North Carolina Medicaid Pharmacy Newsletter, July 2024.

      MEMBER SPOTLIGHT

      FREE Member and Family NARCAN Trainings Available at the Asheville Wellness & Opportunity Center

      Join ACNC and the Sunrise Community for Recovery and Wellness as they offer both in person and virtual NARCAN Training for members and families, every first Tuesday of the month from 10:30 a.m. to 11:30 p.m. This informative training will cover how to use Naloxone, an introduction to harm reduction, and additional details about community support.

      ACNC members can receive free transportation to and from any wellness center event by calling ModivCare for a transport reservation: 1-833-498-2262. Encourage members to reserve a spot by registering, and if virtual Zoom access is needed, please send email to: cwilson5@amerihealthcaritasnc.com.

      Register for NARCAN Training

      The content presented within this training is for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients and should not use the information presented and accompanying materials to substitute independent clinical judgment.

      TRAININGS AND FORUMS

      NEW Quarterly Webinar Series for Behavioral Health Providers

      The ACNC Behavioral Health Provider Network Management team invites you to join a virtual forum to engage with plan leadership to discuss operational and administrative activities. The goal of our time is to get to know each other, share tips and tricks to make your job easier and ultimately work together to improve behavioral health outcomes for our members. Each lunchtime session will include important information related to credentialing, care management, HEDIS priorities, billing functions and more. We will also offer a Provider Spotlight to highlight best practices and encourage patient collaboration.

      Register for Webinar Series

      Register for just one or the entire series.

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

      Thursday, October 10, 2024

      Thursday, January 9, 2025

      Thursday, April 10, 2025

      Thursday, July 10, 2025

      Thursday, October 9, 2025

      Virtual Statewide Quality Forum

      On October 2, 2024, from noon to 1 p.m., the N.C. Department of Health and Human Services Division of Health Benefits (NCDHHS DHB) and N.C. Area Health Education Centers (AHEC), in conjunction with the five Medicaid managed care standard plans, will host the fourth Annual Virtual Statewide Quality Forum. The forum is designed to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives. 

      Register for Quality Forum

      Ongoing Provider Training

      Our Provider Account Executives and Clinical Educators support providers with virtual or face‐to‐face meetings (as feasible), formal training, and ad hoc programs to support care management, prior authorizations, correct billing procedures and other secure online services and programs to identify and improve health outcomes based on HEDIS measures and Opportunities for Health. If you would like a one-on-one, virtual or in-person visit from your dedicated Provider Network Account Executive, inquire via email.

      Visit our Provider Training webpage for the latest offerings including quarterly Clinical Leadership Forums, a new Behavioral Health webinar series, monthly Provider Orientations and NaviNet Provider Portal trainings and a weekly, Electronic Visit Verification (EVV) informal Q&A session specifically for Home Health Providers that bill taxonomy code 251E00000X.

      Providers