February Provider Digest

AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. A Known System Issues Tracker (PDF) Opens a new window is updated weekly and also available in NaviNet to providers.

You will find the following topics in this February digest:

PROVIDER SPOTLIGHT

• ACNC Partnering With Salisbury Pediatrics for Healthy Eating and Asthma Care Initiative

TRAINING AND LEARNING OPPORTUNITIES

• Save the Date: 2026 ACNC Provider Forums
• New On-Demand Content Available to Provider Practices 

MEMBER BENEFITS SPOTLIGHT

• 2026 Regional Baby Showers for Expectant Moms and Families

ON THE ROAD WITH OUR PROVIDERS

• i2i Winter Conference Recap

ADMINISTRATION

• ACNC Eases Administrative Burden With Reductions in Prior Authorization Requirements
• Childhood Immunization Coverage Remains the Same in North Carolina
• CAHPS Survey and Tips to Improve Patient Experience
• Medical Record Data Request for Select Providers
• NaviNet Claim Appeals Status Check Update

QUALITY CORNER

• Providing Care for Patients Recently Discharged from the Emergency Department or Hospital for Substance Use and/or Mental Illness
• Smoking Cessation and Minority Populations

ACNC Partnering With Salisbury Pediatrics for Healthy Eating and Asthma Care Initiative

ACNC kicked off a partnership with Salisbury Pediatrics Associates, PA, with a Game Day Chili Tasting event in October to promote healthy eating and asthma care. ACNC sponsored the event and gave away 50 crockpots to attendees, along with a healthy chili recipe, ingredients and information on ACNC Medicaid benefits and services. Salisbury Pediatrics, based in Salisbury, North Carolina, has 18 providers with varied special interests, ranging from allergies, behavioral health and nutrition to more complex disorders like Crohn's Disease and autism. In July, the clinic launched an Asthma pilot that provides education, labs and follow-up for patients. To learn more about Salisbury Pediatrics, visit their website.

Save the Date: 2026 ACNC Provider Forums

You are invited to join the Provider Network Management team for an informational session at one of our upcoming regional Provider Forums. During these sessions, we will share timely updates on policies, benefits and quality initiatives, as well as ACNC product expansion, value-based programs and claims and billing reminders. Visit the Provider Training webpage for more details and registration information, or reach out to your Provider Account Executive. We hope you will join us at one of the sessions!

New On-Demand Content Available to Provider Practices

ACNC has developed two new training resources to support practice administrators and staff in working with our plan. We hope you will take advantage of these on-demand opportunities:

Let’s Work Together: Provider Orientation Training is a 35-minute overview of practices that are new to our network. The training provides valuable information as a refresher on operations and support available to your practice.

Registering for and Using NaviNet is a 33-minute training course on how to use our provider portal, with helpful tips on checking claims status, accessing clinical reports, the grievance process, and claims attachments.

Please visit our Provider Training page for links to these trainings and other resources.

2026 Regional Baby Showers for Expectant Moms and Families

ACNC continues to focus on improving maternal health outcomes, especially among people of color, by hosting regional community baby showers across the state. Events are hosted by our Wellness & Opportunity Centers, bringing together community partners to educate, empower and support people who are pregnant or have recently delivered a baby, as well as their families. All events are open to the public.

If your practice is interested in partnering with us, participating in one of the baby showers, or promoting it to your patients, please reach out to your Provider Account Executive or call the Provider Services department at 1-888-738-0004.

i2i Winter Conference Recap

Our team enjoyed connecting, learning and sharing ideas with so many of you at the i2i Center for Integrative Health Winter Conference in January. We are proud to be a consistent sponsor of this great event. In addition to being a Gold Sponsor this year, ACNC sponsored the Pre-Conference Medicaid Symposium. Dr. Nerissa Price, our Behavioral Health Medical Director, was the featured speaker during lunch on Wednesday, discussing the importance of partnerships and working together to create innovative ideas. She also participated on the panel “Medicaid Managed Care: Past Lessons, Future Directions.” Congratulations to our door prize winners from ECU Behavioral Health and The Hope Center for Youth and Family Crisis.

ACNC Eases Administrative Burden With Reductions in Prior Authorization Requirements

As of January 1, 2026, ACNC has eliminated prior authorization requirements for 25 codes to ease provider administrative burden. For the most up-to-date information on prior authorizations, refer to our Prior Authorization Lookup Tool. If you have questions about these changes or need further assistance, please contact your Provider Account Executive.

Childhood Immunization Coverage Remains the Same in North Carolina

Following changes announced January 5, 2026, by the Centers for Disease Control and Prevention (CDC) regarding the childhood immunization schedule, the North Carolina Department of Health and Human Services (NCDHHS) reaffirmed that they do not anticipate any changes to the department’s clinical guidance regarding childhood immunizations. ACNC will continue to follow NCDHHS guidance regarding coverage and reimbursement for childhood vaccinations.

CAHPS Survey and Tips to Improve Patient Experience

ACNC collaborates with our providers to help ensure that our members receive comprehensive, quality and culturally responsive care. One of the tools used to evaluate the member care experience is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

In February of each year, a CAHPS survey is mailed to a randomly selected group of ACNC members to ask about their experiences with their providers, health plan and the care they receive.

 Some best practices for improving the patient’s experience include:

• Develop cross-functional integrated care teams to coordinate customized care for patients to improve overall health.¹
• Offer advanced access and same-day scheduling to patients with their primary care provider (PCP).²
• Direct patients to 24-hour nurse hotlines in between appointments.²  ACNC members can reach the Nurse Line by calling 1-888-674-8710 (TTY 1-866-209-6421) 24 hours a day, seven days a week.
• Offer telemedicine for treatment of minor conditions to reduce delays and increase access to patient care.²
• Implement patient portal systems for patients to access practitioner's notes and test results before and after visits.²
• Provide patients with recommended resources and web links from trusted sources during visits.²

If your practice is interested in partnering with ACNC on improving quality outcomes, please contact the ACNC Quality Management team at acncqualitymanagement@amerihealthcaritas.com.

1. Anna C. Greiner and Elisa Knebel, Health Professions Education: A Bridge to Quality, National Academies Press, Washington, D.C., 2003, Chapter 3, “The Core Competencies Needed for Health Care Professionals.”
2. “Section 6: Strategies for Improving Patient Experience With Ambulatory Care,” Agency for Healthcare Research and Quality, edited March 2023, accessed December 31, 2025.

Medical Record Data Request for Select Providers

The annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting period begins in February. ACNC appreciates your cooperation with our efforts to collect medical record data for our members treated by your practice. Records requested should be provided at no charge to the health plan. A frequently asked questions (FAQ) document about this process can be found on the HEDIS and Quality webpage.

ACNC is required to comply with Health Insurance Portability and Accountability Act (HIPAA) privacy requirements throughout the retrieval process and is trained in medical record retrieval for HEDIS, Centers for Medicare & Medicaid Services (CMS), and state quality reporting programs. This data collection is permitted under HIPAA legislation.

If you have any questions, please reach out to the ACNC Quality Management team at acncqualitymanagement@amerihealthcaritas.com.

NaviNet Claim Appeals Status Check Update

At the end of 2025, AmeriHealth Caritas North Carolina and NantHealth|NaviNet expanded the functionality for the submission of appeals regarding claim issues and supporting documentation to include the capability of viewing the status of the appeal and a copy of the determination letter. This notice is to advise providers of a change in the search fields under the Check Status functionality.

The process of viewing the status of a previously submitted appeal has not changed. Providers will continue to access Forms and Dashboards and select the Check Appeal Status link.

The change is the addition of Payee ID to the search data elements. Providers will now be required to search by entering the Payee ID — the provider or group the claim is being paid to — in box 33 of the CMS 1500 claim form, AND one of following data elements:

• Claim ID, OR
• Member ID, OR
• Submission Date Range

The addition of the Payee ID allows our system to better filter the claim status results to help ensure the most accurate response to your search.

New to NaviNet?

If you do not have access to the NaviNet provider portal, please visit the registration page to sign up. To learn more about registering for and using NaviNet, watch our on-demand video training on the Provider Training webpage.

Questions

If you have questions, please contact your Provider Account Executive or the Provider Services department at 1-888-738-0004.

Providing Care for Patients Recently Discharged from the Emergency Department or Hospital for Substance Use and/or Mental Illness

Four HEDIS measures focus specifically on follow-up care for patients recently discharged from the emergency department or hospital for either substance use or mental illness. The goal of these measures is to ensure individuals receive appropriate follow-up care to prevent future readmissions. 

• Follow-Up After Emergency Department Visit for Substance Use (FUA)
• Follow-Up After Hospitalization for Mental Illness (FUH)
• Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)

Best practices for follow-up measures

• Schedule an outpatient visit within seven days of discharge with a mental health/substance use practitioner to make certain that the patient’s transition to home is supported and to ensure that improvements during hospitalization are not lost.¹
• Use telehealth services as a way to interact with the patient, clarify that they understand follow-up instructions, and help them schedule referral appointments. Telehealth visits are reimbursed at the same amount as an in-person visit.²
• Send discharge summaries “directly to the patient’s primary care physician and next care setting within 24 hours” to ensure timely follow up can occur.³
• Encourage patients to read their discharge papers by making them accessible.⁴ Educate patients and staff on the Teach-Back Method to ensure patients and their caregivers understand discharge instructions and the next steps in their follow-up care.³
• Follow up with patients within 24 hours of a missed appointment to maintain engagement.⁵

1. “Quality ID #391 (NQF 0576): Follow-Up After Hospitalization for Mental Illness (FUH) – National Quality Strategy Domain: Communication and Care Coordination,” Quality Payment Program, November 2022, accessed February 4, 2026.
2. “Telehealth for Follow-Up Care,” Health Resources & Services Administration, January 2025, accessed February 4, 2026.
3. “Clinical Guideline: Ambulatory Follow-Up Within 7 Days of Discharge,” Physician Clinical Integration Network, LLC, February 7, 2020, accessed February 4, 2026.
4. Charisma DeSai et al., “Empowering Patients: Simplifying Discharge Instructions,” BMJ Open Qual. No. 10, Vol. 3, September 10, 2021, accessed February 4, 2026.
5. “Connections The Key to Reducing No-Shows: Empower Your Patients,” National Association of Healthcare Access Management.

Smoking Cessation and Minority Populations

In the United States, smoking prevalence varies significantly across racial and ethnic groups. According to the American Lung Association, Hispanic adults usually report a lower rate of cigarette smoking compared to the national average. However, specific Hispanic subpopulations use tobacco at higher rates. For example, those with Puerto Rican origin and Cuban origin have the highest prevalence among the Hispanic population.¹ Hispanic adults born in the United States are at a higher risk for cancer-related illnesses compared to those in their country of origin due to the adoption of behaviors while living in the United States, such as chain smoking.²

Tips for providers when discussing quitting with patients

Effective provider communication is key to helping a member take the steps towards quitting. It is important to approach the conversation in a manner that is non-judgmental, supportive, culturally responsive and patient. Consider implementing the five A’s framework³ to discuss quitting with your patients.

Five A’s: Ask, Advise, Assess, Assist, and Arrange³

Ask — Phrase questions clearly. Deliver messages in an empathic and nonjudgemental way to ensure honest responses for your patients.

Advise — Strongly recommend that every tobacco user quit. Tailor your messages to what matters most to the patient.

Assess — Determine whether the tobacco user is willing to try quitting.

Assist — If a patient wants to quit, either provide counseling or refer them to someone who can provide counseling. Connect them with specialized resources like AmeriHealth Caritas North Carolina Cessation Program or QuitlineNC and address any concerns.

Arrange — “Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.”³ Utilize your electronic health record (EHR) to schedule automated reminders for follow-ups and referrals.

1. “Tobacco Use in Racial and Ethnic Populations,” American Lung Association, November 20, 2024, accessed February 4, 2026.
2. “Tobacco’s Harmful Impact on Hispanic and Latino Americans,” Truth Initiative, September 25, 2025, accessed February 4, 2026.
3. “Five Major Steps to Intervention (The "5 A's"),” Agency for Healthcare Research and Quality, content last reviewed December 2012, accessed February 4, 2026