April Provider Digest
AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. A Known System Issues Tracker (PDF) is updated weekly and also available in NaviNet to providers.
You will find the following topics in this April digest:
PROVIDER SPOTLIGHT
NCDHHS UPDATES
MEMBER BENEFITS
PHARMACY NEWS
- Preferred Drug List Updated
- Patient Assistance Program May Offer Access to Xifaxan and Other Medications
- New Medicaid Direct Pharmacy Benefits Administrator
ON THE ROAD WITH OUR PROVIDERS
ADMINISTRATION
QUALITY CORNER
PROVIDER SPOTLIGHT
Provider Input Helps Improve Quality of Care for ACNC Members
Physician input is essential to AmeriHealth Caritas North Carolina’s (ACNC) success in improving health outcomes. One of the avenues for input is our ACNC Quality Assurance and Performance Improvement (QAPI) Committee, which provides strategic direction to improve quality of care and services delivered to our members. In addition to ACNC medical leaders, Dr. Steve Spalding and Dr. Nerissa Price, the QAPI Committee includes five external providers representing different medical disciplines who play an active role in shaping the direction and specific initiatives of the quality management program.
Thanks to the following providers for their ongoing contributions:
- Alicia Firestone, MD, Atrium Health Wake Forest Baptist Family Medicine, Rock Creek, family medicine and obstetrics
- Amir Barzin, DO, MS, UNC Health Physicians, family medicine
- April Miller, MD, Atrium Health Wake Forest Baptist Obstetrics and Gynecology, Shepherd, obstetrics and gynecology
- Eric Morse, MD, Morse Clinics, addiction and sports psychiatry
- William Stewart, MD, pediatrics
If you are interested in learning more about our advisory committees, please email acncqualitymanagement@amerihealthcaritas.com.
NCDHHS UPDATES
Tobacco-Free Campus Policy Postponed Indefinitely
Effective March 16, 2026, North Carolina Department of Health and Human Services (NCDHHS) revised a prior policy and will now indefinitely postpone the tobacco-free campus requirement. Please refer to the NC Medicaid bulletin Tobacco-Free Campus Policy Requirements Delayed Indefinitely for more information.
MEMBER BENEFIT SPOTLIGHT
ACNC YouTube Channel Offers Original Patient Education Videos
ACNC members can learn more about benefits and services available to them on our YouTube channel. Based on feedback from our Member Advisory Councils, we are building a library of short videos in English and Spanish to help members understand how to use their benefits. If you have suggestions for video content to support our members, please let us know at communications@amerihealthcaritasnc.com. We invite you to subscribe to be up to date on the latest videos.
PHARMACY NEWS
Preferred Drug List Updated
The NC Medicaid Preferred Drug List (PDL) update took effect on April 1, 2026. See NCDHHS Preferred Drug List (PDL) for more information.
Patient Assistance Program May Offer Access to Xifaxan and Other Medications
Bausch Health terminated their CMS Drug Rebate Agreement on October 1, 2025. Drugs manufactured by this company are no longer covered by Medicaid nationwide. This includes popular medications like Xifaxan.
Bausch Health created a Patient Assistance Program (PAP) to help eligible patients in financial need obtain prescription products. To learn more, visit their website.
New Medicaid Direct Pharmacy Benefits Manager
The North Carolina Department of Health and Human Services has awarded a contract to Prime Therapeutics State Government Solutions LLC., to implement a new Pharmacy Benefits Administrator (PBA) solution for NC Medicaid Direct. The PBA will go live on Saturday, May 2, 2026. Beginning on this date, all NC Medicaid Direct Pharmacy claims will be adjudicated through Prime Therapeutics’ system.
Please note: This transition applies only to NC Medicaid Direct and does not impact NC Medicaid Managed Care. For more information, please refer to the NC Medicaid bulletin.
ON THE ROAD WITH OUR PROVIDERS
CCPN Annual Clinicians Conference
ACNC is once again sponsoring the Community Care Physician Network (CCPN) Annual Clinician Conference, May 29th and 30th at the Sheraton Greensboro at Four Seasons in Greensboro, North Carolina. Please stop by our booth to meet our team. Our claims and billing specialists and account executives also are participating in the support center sessions offered during the conference for providers to have one-on-one consults. We look forward to seeing you there!
We were proud to sponsor the North Carolina Pediatric Society 2026 Practice Managers’ Spring Retreat this March. Our team enjoyed engaging with practice managers and sharing insights on how we can support pediatric practices. Congratulations to our door prize winner, Melanie Mock from White Oak Pediatrics.
ADMINISTRATION
Credentialing Reminder
Providers who participate in the Medicaid line of business do not need to complete a separate credentialing application. ACNC mirrors provider and practice information listed in NCTracks. Therefore, it is essential that all providers and practice locations are accurately affiliated within NCTracks to ensure proper enrollment and claims processing with ACNC.
To maintain active participation and avoid interruptions, please ensure the following in NCTracks:
- All rendering providers are affiliated with the correct billing group(s).
- Practice demographic information is current and complete.
- Any new locations, provider terminations or name changes are promptly updated.
If you need assistance updating or verifying your provider information, you may contact NCTracks Provider Services directly by calling NCTracks Customer Service at 1-800-688-6696 or by visiting the NCTracks website.
QUALITY CORNER
Tips to Meet the Prenatal and Postpartum Care (PPC) HEDIS® Measure
The Prenatal and Postpartum Care (PPC) HEDIS® Measure is the percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year.
Two rates are measured:
- Timeliness of Prenatal Care: The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization.
- Postpartum Care: The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery
Best practices to meet the Prenatal and Postpartum (PPC) measure include:
- Schedule the first prenatal visit in the first 10 weeks of pregnancy with an OB/GYN, primary care provider, or other prenatal practitioner. Nurse visits do not count for the measure.1
- Remind patients of their appointments via phone calls, emails or texts.2
- Educate patients on the importance of the initial prenatal visit and the importance of keeping each prenatal and postpartum appointment.
- Utilize CPT Category II codes to capture the date of the first prenatal visit and the postpartum visit.
- 0500F – Initial prenatal visit
- 0503F – Postpartum visit
AmeriHealth Caritas North Carolina offers members a $35 CARE Card reward for a prenatal visit and $40 for a postpartum visit within 7 to 84 days after delivery.
1 Sarah Inés Ramírez, “Prenatal Care: An Evidence-Based Approach,” Am Fam Physician, Vol. 108, No. 2, August 2023, accessed April 2, 2026.
2 Ziaur Rahman and Shafiul Alam Bhuiyan, “SMS Medicine: Revolutionizing Healthcare Delivery Through Mobile Technology,” Annals of Innovation in Medicine, Vol. 2, No. 4, November 27, 2024, accessed April 2, 2026.
Social Determinants of Health and Low Birth Weight
Low birth weight (LBW), defined as a neonatal weight of less than 5 pounds, 8 ounces, affects 1 out of 12 infants in the United States and is widely recognized as a public health concern. Infants with LBW are at elevated risk for infant mortality, developmental delays and long-term health complications. These babies may also face other health conditions, such as diabetes, heart disease and high blood pressure, later in life.1
Pregnant individuals are especially vulnerable to adverse outcomes related to unmet basic needs connected to social determinants of health (SDOH). When basic social, economic and environmental needs remain unfulfilled, the likelihood of LBW increases.2
Ways that providers can intervene
Clinical interventions alone cannot address the multifactorial origins of LBW. However, through comprehensive prenatal care, providers can play a pivotal role in mitigating the impact of SDOH on birth weight:3
- Screening: Systematically incorporate SDOH screening into prenatal visits to identify needs related to housing, nutrition, transportation and mental health at an early stage.
- Connection: Establish partnerships with community organizations to link patients to community resources.
- Education: Offer targeted education on nutrition, stress management and health literacy to empower patients.
- Advocacy: Champion policy and program changes that expand access to maternal health services, reduce inequities and improve long-term outcomes.
Delivering culturally competent care — including language access, respectful communication and awareness of systemic barriers — empowers pregnant individuals to be more open about their actual needs and get the care they need throughout their pregnancy.4
Through collaboration and integrating SDOH into clinical care, health care providers and community partners can help reduce disparities in birth outcomes, improve maternal health and infant survival, and strengthen families and communities in the long term.
1 “Low Birthweight,” March of Dimes, June 2021, accessed February 13, 2026.
2 Guillermina Girardi, et al., “Social Determinants of Health in Pregnant Individuals From Underrepresented, Understudied, and Underreported Populations in the United States,” Int J Equity Health, Vol. 22, No. 186, September 6, 2023, accessed April 2, 2026.
3 “Social Determinants of Health: Improving Maternal and Infant Health Requires More Than Clinical Care,” Progeny Health, accessed April 2, 2026.
4 Jon-Michial Carter, “Why Cultural Competence is Essential to Delivering Patient-Centered Care, “ ChartSpan, February 23, 2026, accessed April 2, 2026.