July 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 July digest:
PROVIDER UPDATES
PROVIDER RESOURCE
POPULATION HEALTH
MEMBER BENEFITS SPOTLIGHT
ON THE ROAD WITH OUR PROVIDERS
PHARMACY NEWS
ADMINISTRATION
- New Provider Account Executive Coverage Map
- Refer Your Patients to the ACNC Complex Care Management Program
- NaviNet® Dispute Letter Access Update
QUALITY CORNER
PROVIDER UPDATE
Federal Changes to Medicaid Beginning October 1, 2026
The North Carolina Department of Health and Human Services (NCDHHS) has begun notifying affected Medicaid beneficiaries about two upcoming eligibility changes under H.R. 1, the new federal Medicaid law.
The changes include noncitizen coverage updates, effective October 1, 2026, and Medicaid expansion work, renewal and eligibility requirements, effective January 1, 2027.
NCDHHS has developed a webpage to help Medicaid beneficiaries, providers and community-based organizations understand these changes and learn what steps members can take if they are affected.
PROVIDER RESOURCES
Earn Up to $350 Per Care Gap Closed in Our 2026 Value-Based Programs
The PerformPlus Gaps in Care programs for 2026 kicked off July 1. Through these behavioral health, maternity care and primary care programs, providers may be eligible to receive an annual per-gap-closure incentive for each member assigned to their practice who meets the population and compliance criteria for selected quality measures.
ACNC offers updated quality tools and resources to help providers and their staff report the clinical data needed to close gaps in care. These resources reflect the most current Healthcare Effectiveness Data and Information Set (HEDIS) information.
Updated resources include:
- The HEDIS 2026 Comprehensive Provider Education Tool found on NaviNet
- HEDIS Supplemental Data Exchange Handbook (PDF)
- Care Gaps That Can Be Closed in the NaviNet Care Gap Response Form (PDF)
We also provide a monthly article in every digest, the Quality Corner, which provides best practices and tips for improving gaps in care in every digest. This is posted to the HEDIS and Quality webpage. For questions or more information, please contact your Account Executive. They can help your practice review data and share best practices for closing gaps.
POPULATION HEALTH
Your Feedback Needed on Tobacco Cessation Program Offerings
Help us better support members who are working to quit tobacco products by completing a brief Tobacco Cessation Provider Survey. Your feedback will help us understand current tobacco cessation practices, common barriers to counseling conversations, and provider training and support needs.
Remember, counseling patients who smoke cigarettes, tobacco or vape products to quit is a billable service under NC Medicaid.
Thank you for taking the time to share your input. Learn more about ACNC smoking cessation services on our website.
MEMBER BENEFITS SPOTLIGHT
ACNC continues to focus on improving maternal health outcomes, especially among moms of color, by hosting regional community baby showers for hundreds of moms and families across the state. Our Quality Team partners with our Wellness & Opportunity Centers and other community agencies to host events to educate, empower and support expecting and new moms and their families.
We encourage you to promote these events among your patients and are happy to provide you with flyers or registration information. If your practice is interested in partnering with us or participating in one of the baby showers, please reach out to your Provider Account Executive or call Provider Services at 1-888-738-0004.
Date | Location |
|---|---|
| Wednesday, August 5 | Charlotte Wellness & Opportunity Center |
| Wednesday, September 9 | Greenville Wellness & Opportunity Center |
| Wednesday, September 30 | Greensboro Wellness & Opportunity Center |
ON THE ROAD WITH OUR PROVIDERS
Connect with ACNC at the North Carolina Pediatric Society 2026 Annual Meeting
ACNC is pleased to sponsor the Networking Lounge at the North Carolina Pediatric Society 2026 Annual Meeting, taking place August 28 – 30 in Durham, North Carolina. In addition to our Networking Lounge sponsorship, we will also have an exhibit. Stop by our booth in the Rotunda Room to meet our team and register to win a gift basket!
PHARMACY NEWS
New Resource: Biosimilar Preferred Drug List Updates Webpage
ACNC has created a quick-reference webpage for the recently updated preferred biosimilar drug list. The webpage features an easy-to-read table of Food and Drug Administration-approved biosimilar and interchangeable biosimilar products that require prior authorization and are preferred medications on the NC Medicaid PDL. It also includes helpful resources providers can use to educate patients about biosimilar products.
As a reminder, the Pharmacy webpage provides current information about covered member prescriptions and other pharmacy services, including copays, prior authorization and medication limits.
Preferred Drug List (PDL) Updated in July
The NC Medicaid Preferred Drug List (PDL) update took effect in July.
ADMINISTRATION
New Provider Account Executive Coverage Map
ACNC has created an Account Executive Coverage Map to help providers and practice staff quickly find the right contact and improve communication. Use this resource to identify and connect with your Provider Account Executive when you have questions or need assistance.
Refer Your Patients to the ACNC Complex Care Management Program
ACNC offers a Complex Care Management (CCM) program to assist members with one or more chronic conditions. CCM promotes quality, cost-effective outcomes according to evidence-based practice and clinical guidelines for specific clinical conditions. The Complex Care Management program connects members with a care manager that can help them:
- Understand and manage their chronic health conditions.
- Identify their medical and nonmedical needs.
- Understand their medications.
- Set goals to improve their health.
- Find the right doctors and specialists to manage their care.
- Connect to available resources in the community.
If you have a member that would benefit from complex care management, refer them to the program by calling ACNC Member Services at 1-855-375-8811 (TTY 1-866-209-6421) or the Rapid Response and Outreach Team at 1-833-808-2262. Learn more on the Special Health Programs webpage.
QUALITY CORNER
Cervical Cancer Screening (CCS-E) Measure
The HEDIS® Cervical Cancer Screening Measure (CCS-E) is the percentage of individuals 21 – 64 years of age who were screened for cervical cancer using any of the following criteria:
- 21 – 64 years of age who had a cervical cytology (Pap Test) performed within the last three years
- 30 – 64 years old who had cervical high-risk human papillomavirus (hrHPV) testing within the last five years
- 30 – 64 years old who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last five years
Rates of cervical cancer screening (PDF) among NC Medicaid beneficiaries have historically been significantly lower than the national average. Increasing awareness is especially important given historically low human papillomavirus (HPV) vaccination uptake among NC Medicaid beneficiaries.
Best practices
- Always include dates of service, specific test names and results in the medical record.
- “If screening is due or overdue, incorporate discussions about screening into every appointment to avoid missed opportunities.”
- Develop a reminder system or flag patient files to identify which patients are due for a cervical cancer screening test.
- Offer human papillomavirus (HPV) self-collection tests when clinically appropriate.
- Due to past trauma, some people are uncomfortable with being examined.
“Ask about a patient’s comfort without requiring them to disclose trauma and offer alternatives to improve their comfort.” - To prevent traumatization of patients with a history of adverse childhood experiences (ACEs) or trauma, follow the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) principles of trauma-informed care.
Providers can earn incentives for providing high-quality and cost-effective care. Beginning July 1, 2026, ACNC providers are eligible for the ACNC’s Gaps in Care for Maternity Care Program. If you have any questions about the program, please contact your Provider Account Executive.