January Provider Digest

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

RESOURCES

TRAINING

NC Health Choice (North Carolina’s CHIP program) is moving to Medicaid.

On April 1, 2023, approximately 55,000 children (aged 6 – 18) who are currently enrolled in NC Health Choice will move to Medicaid. Beneficiaries moving from NC Health Choice to Medicaid will be eligible to receive additional benefits, including:

  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) to discover and treat childhood health conditions before they become serious
  • Assistance getting to and from Medicaid-covered services through non-emergency medical transportation (NEMT) services
  • Prenatal care, childbirth, and postpartum care
  • No enrollment fees or copays (Many NC Health Choice beneficiaries were required to pay a fee to enroll in the program, in addition to copays for medical visits and prescriptions.)

Session Law 2022-74 (HB 103), enacting this legislative and policy change, was passed by the North Carolina State legislature and signed into law by Governor Roy Cooper on July 11, 2022.

Beneficiaries do not need to take any action to move to Medicaid. Their Medicaid ID (Recipient ID) number will not change.

  • Beneficiaries will receive a notice from the department in March 2023 regarding the change in benefits.
  • They will receive a Medicaid ID card that will replace their NC Health Choice ID card.
    • Beneficiaries in Medicaid Managed Care will receive a Medicaid ID card from their health plan.
    • NC Medicaid Direct beneficiaries will receive a Medicaid ID card from NC FAST.

North Carolina Medicaid Standard Plan and Tailored Plan Tobacco-Free Policy Requirements

NC Medicaid has released an updated bulletin on the Standard and Tailored Plan Tobacco-Free Policy Requirements:

"With the Tailored Plan launch on April 1, 2023, NCDHHS will delay the implementation of Tobacco-Free Policy requirements for both North Carolina Standard and Tailored Plans."

"Prior to Tailored Plan launch, the Department will work with key community stakeholders, Standard Plans and Tailored Plans to revise guidance on the policy requirements. More information will be provided about the program in Spring 2023."

This means providers will have more time to have a positive and collaborative implementation process for their tobacco-free campus policies. We encourage providers to take advantage of this time to use the technical assistance and resources available through the tobacco control regional manager assigned to your county and the resources available at breatheeasync.org.

RESOURCES

Reminder: Appointment 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 preventative, routine and urgent care services for prenatal, primary, specialty and behavioral health care scheduling. Please review pages 21-26 of the Provider Manual (PDF) and consider where your access could be improved.

Vision Services for Adults

AmeriHealth Caritas North Carolina (ACNC) has a value-added service for ACNC members. Detailed information about this benefit is provided below. Review and download the extra benefits flyer (PDF) for ACNC Members, and feel free to share with your patients.

Benefit Description:

  • Member eligibility can be verified using ACNC’s provider portal, NaviNet.
  • Provides for an additional pair of glasses and an additional eye exam every two years to adult members ages 21 – 64 in addition to the regular Medicaid benefit.
  • Vision care is a covered benefit under Medicaid managed care. Any claim for a vision exam should always be billed to ACNC.

Nash Optical — First Pair of Glasses:

  • Per North Carolina state law, to qualify for this benefit, members must have received their first pair of glasses through Nash Optical, the state supplier.
  • Vision providers should check the NC Tracks system to confirm that a pair of Medicaid fee-for-service glasses has been dispensed to the member within two years before the value-added benefit can be used. 
  • If the provider has a question regarding the Medicaid fee-for-service glasses, it should be directed to the NC Medicaid Contact Center.

TRAINING

Let's Work Together: New Provider Orientation

For 2023, ACNC presents Let's Work Together, our reinvented provider orientation, with the goals of introducing our Account Executive team members and of sharing the tools necessary to be a successful provider in our network. We will meet February through December on the 2nd Tuesday of each month from Noon – 1:00 PM EST. Sign up for a training in 2023, and join us to learn the following:

  • Our care delivery model
  • Quality management and value-based care tools can improve outcomes for our members
  • Eligibility, membership benefits and value-added services
  • Using the NaviNet portal
  • Provider compliance
  • Initiatives: Healthy Opportunities Pilots, Smoking Cessation and The Tailored Plan

2023 Substance Use Disorders (SUD) TeleECHO Clinic

The 2nd and 4th Thursdays of each month from January through April 2023, from Noon – 1:00 p.m.

Register for the series.

Download the Substance Use Disorder TeleECHO Training Series Flyer for 2023 (PDF).

Solution for Online Prior Authorizations Training: NaviNet Medical Authorizations

Register for one of the following Wednesdays from Noon – 1:00 PM: February 15, March 15 and April 19, 2023.

Earn CMEs/CNEs with Our No-Cost Training Presented by Physicians for Social Responsibility

To register in advance for a date and time that’s convenient, visit our Featured Training webpage. Multiple training sessions are being offered through March 16, 2023.

Early Periodic Screening, Diagnostic and Treatment (EPSDT) Video Training

This training is now on our website for review.

Providers