April Provider Digest
AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. You will find the following topics in this April digest:
- Virtual Self-Care and Burnout Prevention Workshop for Providers
- Introducing Dr. Price, Behavioral Health Medical Director
QUALITY CORNER
PHARMACY
MEMBER BENEFIT SPOTLIGHT
REMINDERS
- Substance Use Disorder Services Are Part of the Standard Plan Service Array
- Post-Appointment Survey Provider Scorecard Available in NaviNet
- Use the Correct Payer ID When Filing Claims
- Prior Authorization Reminder
- Rapid Response and Outreach Team and Screenings
TRAININGS AND FORUMS
- Support in Navigating Electronic Visit Verification
- Change for Life: Tobacco-Free Recovery NC Meeting
- Let’s Work Together: Provider Orientation
- 2024 Clinical Leadership Forums
Virtual Self-care and Burnout Prevention Workshop for Providers
May is Mental Health Awareness month, and our new Behavioral Health Medical Director has an important workshop for you. If you believe that life in medicine seems to have gotten harder, it’s not your imagination. Chronic imbalance between work pressures and our ability to manage them can lead to burnout. Burnout is a serious occupational phenomenon that has dramatically increased in our world. However, fortunately, burnout can be mitigated with intentional strategies. This no-cost, virtual workshop will help you identify the causes of burnout, recognize the risks and discuss practical individual and organizational strategies for prevention and management.
Presenter: Dr. Nerissa Price, ACNC Behavioral Health Medical Director
Date: May 22, 2024
Time: Noon – 1:00 pm ET
Introducing Dr. Price, Behavioral Health Medical Director
Dr. Nerissa Price, MD, joined the AmeriHealth Caritas North Carolina team in January 2024. She is a child, adolescent and adult psychiatrist who brings more than 20 years of experience in a variety of settings across North Carolina.
Dr. Price is responsible for developing and overseeing implementation of the plan’s behavioral health strategy and ensuring effective execution and scaling to improve population health and wellness outcomes. She serves as a behavioral health subject matter expert for the plan.
Prior to joining AmeriHealth Caritas North Carolina, Dr. Price worked with the University of North Carolina (UNC) School of Medicine; ValueOptions; Cardinal Innovations; the North Carolina Department of Public Safety; and most recently, at WakeMed in Raleigh. At WakeMed, she was the medical director for Behavioral Health Community Case Management and the homeless outreach team (H.E.A.R.T). She served as medical director of WakeMed Physician Practices’ Well-Being Initiatives, where her mission was to improve provider well-being by promoting the culture of wellness, work-life integration and joy in work. Dr. Price has devoted her career to improving the health of those who experience mental illness and are marginalized in our society.
Dr. Price is a Wake County native. She received her medical degree and completed a Child and Adolescent Psychiatry Fellowship at the University of North Carolina at Chapel Hill School of Medicine, and she is board-certified in general psychiatry.
Chlamydia Screening in Women (CHL) HEDIS Measure
Chlamydia Screening in Women (CHL) is the percentage of women 16 – 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.1
April is Sexually Transmitted Infections (STI) Awareness month and a great time to focus on reaching out to patients who are due or overdue for this screening. Using the ACNC care gap report within NaviNet can assist you with the identification of those patients.
It is also important to note that if a patient between 16 and 24 years of age is seen in the emergency room with complaints of abdominal pain, they will be given a pregnancy test, which will automatically place them in the Chlamydia Screening in Women (CHL) measure.
Best CHL practices2:
- Reminder phone calls or text messages
- Educate patients on the importance of annual preventive visits and the value of chlamydia screening.
- Screenings can be performed during routine and acute care visits.
- Screen all women who are prescribed or use birth control.
- Consider universal urine testing for all, especially women ages 16 – 24.
CHL coding/documentation3:
- CPT: 87110, 87270, 87320, 87490, 87491, 87492, 87810, 0353U
- HCPCS: G9820
Please contact your Provider Network Management Account Executive with any questions. For providers that would be interested in partnering with ACNC on screening events, please contact ACNC quality management by email at acncqualitymanagement@amerihealthcaritas.com
Citations:
1“Chlamydia Screening in Women (CHL),” National Committee for Quality Assurance
2“CHL - Chlamydia Screening in Women,” Johns Hopkins Medicine
3“Chlamydia Screening in Women (CHL),” Horizon Blue Cross Blue Shield of New Jersey
Regional Baby Showers
ACNC kicked off our 2024 Baby Shower event series at our Fayetteville Wellness & Opportunity Center in March. Moms-to-be and their families enjoyed a healthy cooking demonstration, hands-on CPR training and visits with providers and other vendors in the community. The goal of these events is to educate, empower and support people who have recently delivered a baby or who are pregnant, as well as their families.
Our baby showers offer us a chance to celebrate the arrival of new babies and encourage moms to get the prenatal and postpartum care and support they need as we work to improve maternal health outcomes, especially among people of color. Events are planned over the next few months in Raleigh, Charlotte and Asheville. Please encourage your patients to register via the event calendar links on the Wellness & Opportunity Centers webpage. ACNC members can get no-cost transportation to any of our sponsored events through our transportation provider, Modivcare.
If your practice is interested in participating in a baby shower event, please send an email to acncqualitymanagement@amerihealthcaritas.com.
| Region 4 Baby Shower |
Poe Center for Health Education |
Saturday, April 20, 2024 |
|---|---|---|
| Region 1 Baby Shower |
Asheville Wellness & Opportunity Center |
Tuesday, June 4, 2024 |
| Region 3 Baby Shower |
Charlotte Wellness & Opportunity Center |
Saturday, August 3, 2024 |
|
Visit our community webpage for links to all our Wellness & Opportunity Center event calendars. |
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The NC Medicaid Preferred Drug List update is effective as of April 1, 2024. For assistance with pharmacy prior authorizations or pharmacy claim questions, contact PerformRxSM Provider Services at 1-866-885-1406.
NC Medicaid Pharmacy Copayment Requirements Reminder
If a member cannot afford to pay their copayment at the time of service, a provider cannot refuse to provide service. Refer to Pharmacy Policy 9 under section 5.5 Co-Payments. The specific guidance is below, with the reference.
5.5.1 Medicaid Co-payment Requirements
An eligible Medicaid beneficiary, who receives prescribed drugs, is required to make a co-payment of $4.00 for each prescription received unless they are exempt for one of the reasons listed below in Subsection 5.5.2. A provider may not deny services to any Medicaid beneficiary because of the individual’s inability to pay a deductible, coinsurance or co-payment amount. A provider may not willfully discount copays for a Medicaid beneficiary, and an individual’s inability to pay does not eliminate his or her liability for the cost sharing charge. The provider shall open an account for the beneficiary, collect the amount owed at a later date, and document all attempts to collect the copay. If the account has not been paid, the pharmacy may in the course of normal accounting principles, write-off the charges and stop monitoring the claim.
Reference: North Carolina Medicaid Pharmacy Newsletter, No. 363
Vision Services for Adults
ACNC members are eligible for an extra pair of prescription eyeglasses in addition to their Medicaid benefit.
Benefit description:
- Member eligibility can be verified using ACNC’s provider portal, NaviNet.
- This benefit provides 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.
Substance Use Disorder Services Are Part of the Standard Plan Service Array
To further improve rapid access and reduce barriers to substance use disorder (SUD) services for members enrolled in a Standard Plan, NC Medicaid added the Substance Abuse Intensive Outpatient Program (SAIOP), Substance Abuse Comprehensive Outpatient Treatment (SACOT) and social setting detox to the NC Medicaid Standard Plan service array. Read more by visiting this North Carolina Department of Health and Human Services (NCDHHS) blog post.
Post-Appointment Survey Provider Scorecard Available in NaviNet
ACNC works in collaboration with our providers to help ensure that our members receive comprehensive, quality and culturally responsive care. One of the tools we use to evaluate the member care experience is our Post-Appointment Member Satisfaction Survey.
We are pleased to announce that providers will now be able to 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.
Use the Correct Payer ID When Filing Claims
Please note that ACNC operates two different health plans in North Carolina. To enable prompt payment, please be careful to charge your claim to the correct AmeriHealth Caritas North Carolina Medicaid or AmeriHealth Caritas Next payer ID. Improper claim submission could result in rejected claims, denied claims and payment delays.
The ACNC Claims and Billing Manual (PDF) has recently been updated on our website. Please consult the table below for the appropriate plan payer ID.
| Plan name | Plan type | Plan payer ID |
|---|---|---|
|
AmeriHealth Caritas North Carolina |
Medicaid |
81671 |
|
AmeriHealth Caritas Next |
Individual and family health plans both on and off the Health Insurance Marketplace® |
83148 |
Prior Authorization Reminder
Durable medical equipment (DME) providers and those requesting authorizations for medically necessary units or specific procedures should review the North Carolina Department of Health and Human Services (NCDHHS) Program Specific Clinical Coverage Policies before submitting a request. If your authorization request exceeds the established NCDHHS Program Specific Clinical Coverage Policy limits, providers should indicate “unit exception request” anywhere in the Service Information section of the prior authorization request form (PDF), as highlighted here:
Rapid Response and Outreach Team and Screenings
Did you know that the ACNC Rapid Response and Outreach Team assists parents and guardians of members with access and arrangements for needed services identified through Early and Periodic Screening, Diagnostic and Testing (EPSDT) screens? At-risk children (ages 0 – 5) with service gaps are identified, and the parents/guardians are educated on the EPSDT screenings, immunizations and services that are due. This team also assists with the coordination of services needed. You can find this and additional information on the topic of EPSDT by visiting the dedicated EPSDT webpage.
Support in Navigating Electronic Visit Verification
To support home health providers in the transition to the Electronic Visit Verification (EVV) process, ACNC is offering a new weekly series titled Navigating Electronic Visit Verification, Crosswalks and More. During these sessions, offered each Wednesday at 5 p.m.ET, ACNC will share a crosswalk developed to simplify the verification and billing process, including the necessary steps to establish a connection with the vendor, HHAExChange, and cover how to bill claims. Our team also will be prepared to address specific concerns and obstacles facing providers in this transition.
Register for a weekly session date through the end of May. Sign up at least a week in advance AND complete the survey, answering all the necessary questions so we can better support you.
Register for Navigating Electronic Visit Verification, Crosswalks, and More
Change for Life: Tobacco-Free Recovery NC Meeting
On April 25, 2024, from 9:00 – 10:15 a.m. ET, the team at TROSA will discuss: How to integrate tobacco (nicotine) treatment into an existing SUD treatment model for holistic substance use disorder care and maintaining a tobacco-free campus. (Reprinted with permission from Stephanie Gans from NCDHHS.)
Register for Tobacco-Free Recovery NC Meeting
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.
2024 Clinical Leadership Forums
ACNC is pleased to provide opportunities for providers to engage with our team to discuss quality improvement activities and associated challenges related to quality and population health outcomes. Each lunchtime session includes a Provider Spotlight to highlight best practices, as well as open discussion with participants.
| Women’s Health and Wellness |
Due to ACNC holiday, webinar is Thursday, June 20, 2024 |
|---|---|
| Physical Health Chronic Conditions |
Wednesday, September 18, 2024 |
| Childhood Health and Wellness |
Wednesday, December 18, 2024 |