March 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 March digest:

• May 1, 2025, Deadline for Providers Offering Home Health Care Services (HHCS) with Electronic Visit Verification (EVV) Process
• Grant Opportunity for Collaborative Care Management (CoCM)
• Clinical Champions and Operational Leads Are Invited to the ACNC Clinical Leadership Forums

QUALITY CORNER

• Best Practices for Providing Care for Patients Recently Discharged From the Emergency Department or Hospital for Substance Use Disorder and/or Mental Illness
• Reminder: Appointments Wait-Time Standards

CLAIMS AND BILLING

• Your Claims. Paid Right. The First Time.
• Security Improvements to NaviNet Provider Portal

MEMBER SPOTLIGHT

• Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• Regional Baby Showers for Expectant Moms and Families

REMINDERS

• ACNC Eases Administrative Burden and Improves Member Access With Reductions in Prior Authorization Requirements
• Restoration of Optum/Change Healthcare Connectivity

May 1, 2025, Deadline for Providers Offering Home Health Care Services (HHCS) with Electronic Visit Verification (EVV) Process

This update is specifically for the home health providers that bill taxonomy code 251E00000X. North Carolina Department of Health and Human Services (NCDHHS) reinstated an EVV hard launch date for HHCS providers as of May 1, 2025.

Providers are encouraged to begin submitting visit information using one of the two options below. 

1. Submit all visit information through HHAeXchange (HHAX) portal for claims creation.

• Make sure your portal has been created. Being registered does not guarantee creation.
• Member visit and EVV information must be submitted through your HHAX portal.
• An updated Service Codes Crosswalk with HCPCS and Revenue Codes is found in the HHAX portal or on the ACNC Provider Manuals, Policies and Forms webpage.

2. Direct claims billing with ACNC after visit submission via HHAX.

• Make sure your portal has been created in HHAX. Being registered does not guarantee creation.
• The billed charge, number of units, and the invoice numbers are submitted directly to ACNC.
• Providers can include supplies on the claim information submitted to ACNC.
• If selecting this option, providers are still required to submit EVV information (date of service, billing codes, diagnosis, etc.) through HHAeXchange.
• An updated Service Codes Crosswalk with HCPCS and Revenue Codes is found on the ACNC Provider Manuals, Policies and Forms webpage.

An informal webinar Q&A session is offered every Wednesday at 5 p.m. and discusses the necessary steps to establish a connection with HHAX and covers the options for billing claims. Register for an upcoming session.

Register for webinar

For a more complete description of services, see NCDHHS Medicaid Clinical Coverage Policy 3A for Home Health Services. ACNC has a designated team of Provider Network Management Account Executives to support training and billing. Reach out to us anytime, and we look forward to seeing you on an upcoming Wednesday evening.

Grant Opportunity for Collaborative Care Management (CoCM)¹

“The NC General Assembly has allocated $5 million for capacity building of Medicaid-enrolled primary care practices across the state to adopt CoCM.” 

“CoCM improves patient outcomes, increases satisfaction for both patients and providers, and reduces healthcare costs and stigma related to mental health and substance use disorders. The model complements other integrated models, including the North Carolina Psychiatric Access Line (NC-PAL).” 

“For more information about the CoCM model and training opportunities, explore NC AHEC and the AIMS Center.”

Review the CoCM Capacity Building Fund one-sheet (PDF) for support when applying for the grant.

Clinical Champions and Operational Leads Are Invited to the ACNC Clinical Leadership Forums

ACNC hosts clinical leadership forums to share how your practice can earn more in ACNC incentive payments and discuss activities that can save you time. These virtual lunch-and-learn sessions are hosted by our clinical leadership in physical and behavioral health. See upcoming topics and dates below, and visit our Provider Training webpage for more free training opportunities.

Best Practices for Providing Care for Patients Recently Discharged From the Emergency Department or Hospital for Substance Use Disorder and/or Mental Illness

There are three specific HEDIS measures that focus on patients recently discharged for substance use and mental illness. These measures are:

• Follow-Up After Emergency Department Visit for Substance Use (FUA) — The percentage of emergency department (ED) visits for members 13 years and older that had a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, and there was a follow-up visit after discharge.
• Follow-Up After Hospitalization for Mental Illness (FUH) — The percentage of discharges for members 6 years and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider.
• Follow-Up After Emergency Department Visit for Mental Illness (FUM) — The percentage of emergency department (ED) visits for members 6 years and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness.

Best practices for follow-up measures^2,3,4,5

• “The follow-up appointment should be made with a mental health” or substance use provider “before the patient” is discharged from the ED or hospital “and should be scheduled between one to seven days after discharge.”⁴ Telehealth services are ideal to ensure timely appointments.
• “Discharge summaries should be sent directly to the patient’s primary care physician and next care setting within 24 hours”⁴ so timely follow up can occur.
• Educate “patients and staff on the ‘Teach Back Method’ to ensure patients and caregivers review and understand discharge instructions and the next steps in their care for follow-up.”^2,3
• “Encourage the patient to bring their discharge paperwork to their first appointment.”²
• “Educate the patient about the importance of follow-up and adherence to treatment recommendations.”²
• “Outreach to patients who cancel appointments and assist them with rescheduling as soon as possible.”²

Reminder: Appointments Wait-Time Standards

Throughout the year, NCDHHS requires ACNC to complete timely wait audits to support members’ ability to schedule appointments within a reasonable amount of time. Appointment wait times refer to preventive, routine and urgent care services for prenatal, primary, specialty and behavioral health care scheduling. Please review pages 24 – 26 of the Provider Manual (PDF) and consider where your access could be improved.

Your Claims. Paid Right. The First Time.

Visit the updated Claims and Billing webpage for additional information and links to other resources and support. Our Claims and Billing Manual has been updated to version 11 and posted to our website.

To avoid pending claims, delay of payment, rejections and denials, submit claims as soon as reasonably possible, and remember to attach documentation. Accuracy will help ensure your claims are clean and ready for submission.

Security Improvements to NaviNet Provider Portal

NantHealth has implemented additional security measures to the NaviNet provider portal registration process. This applies only to providers that are new to NaviNet and includes automated verification checks to confirm the identity of each practice. NantHealth will conduct a manual review of submitted practice documentation to further validate each registration request.

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

AmeriHealth Caritas North Carolina works in collaboration with our providers to help ensure that our members receive comprehensive, quality, and culturally responsive care. One of the tools used to evaluate member care experience is the CAHPS survey. Our members will begin receiving the CAHPS survey by mail between February and April this year. The survey field closes in May, and we can expect the survey results in spring 2026.

Regional Baby Showers for Expectant Moms and Families

In 2025, ACNC will continue working to improve maternal health outcomes, especially among people of color, by hosting quarterly regional community baby showers around the state. Our Quality Team has partnered with our Wellness & Opportunity Centers and numerous community partners to host events in every region to educate, empower and support people who have recently delivered a baby or who are pregnant, as well as their families.

Along with our transportation vendor, ModivCare, we invite local stakeholders to participate in wrapping these families who have recently had a baby or who are expecting one with community support.

Visit the 2025 calendar of events on our Community Outreach webpage for baby showers near you.

ACNC Eases Administrative Burden and Improves Member Access With Reductions in Prior Authorization Requirements

Member access to timely, high-quality physical and behavioral health care is the highest priority for ACNC. We recognize that valuable treatment time can be lost for our members when providers are saddled with overly restrictive processes.

As part of our ongoing commitment to members and providers, ACNC has eliminated prior authorization requirements for more than 1,900 physical and behavioral health procedure codes since 2023.

The latest updates took effect January 1, 2025:

• Prior authorization and notification requirements have been removed for more than 240 physical health codes, including a select number of durable medical equipment, physical and occupational therapies, orthotics and prosthetics, and surgery codes.
• To further our goal of mental health parity, notifications are no longer required for behavioral health codes and prior authorization requirements were eliminated for more than a dozen services including, but not limited to, facility-based crisis treatment, mobile crisis management, and outpatient treatments

For the most up-to-date information on prior authorizations for all services, if you have questions about these changes, or if you have further suggestions, please reach out to your dedicated ACNC Account Executive.

Restoration of Optum/Change Healthcare Connectivity

ACNC has restored connectivity with Optum/Change Healthcare. Please see the Claims and Billing webpage for the most up-to-date options for claims submission. Manual (or direct) entry and electronic submission (including 275 attachments) are both available. If you have questions, please contact your Provider Network Management Account Executive or Provider Services at 1‑888-738-0004.