NC Medicaid Provider Questions and Trainings

As the state of North Carolina plans to go live with Medicaid Transformation on July 1, 2021 for beneficiaries with a primary physical health care diagnosis, behavioral health providers are needed. Under Medicaid Transformation, integrated care is a goal. Standard Plans will serve mild to moderate behavioral health care needs. NASW-NC is assisting members with questions. Please do not hesitate to reach out for assistance to Kay Castillo at kcastillo.naswnc@socialworkers.org.

Enrollment update: NC DHHS Extends Open Enrollment through May 21. 

A few common questions we have received:

• Can Associate level licensees enroll into Standard Plans?
  Yes. If you are enrolled in Medicaid and provide services available through Standard Plans, the Standard Plan is required to offer you a contract. If you have specific examples of Standard Plans who are not allowing you to contract, please send to the Medicaid Provider Ombudsman Medicaid.ProviderOmbudsman@dhhs.nc.gov, and they can help resolve.
• How frequently will providers be paid?
  Per the Provider Playbook, Standard Plans have up to eighteen days to pay claims. Standard Plans are subject to a state insurance law relating to timely payment of claims and are subject to expectations outlined in the Prepaid Health Plan (PHP) Contract relating to timely payment.  A PHP cannot negotiate this time period.  The state does expect that a certain amount of claims will be processed before the deadline of eighteen days.
• Can I negotiate my provider rate?
  Providers who are unhappy with reimbursement rates are encouraged to negotiate their rates with Standard Plan networks. Let them know what the LME/MCO currently pays you for claims. Additionally, the Provider Ombudsman is tracking all concerns from providers to develop action with each Standard Plan network. They can be contacted at Medicaid.ProviderOmbudsman@dhhs.nc.gov. 
• Who is providing services under Medicaid Transformation?
  Check out Health Plan Contacts and Resources for information on the plans and provider contact information.
• How do I check if my information is correct for beneficiaries to find me in the provider directory?
  See Provider Trending Topics and additional FAQs for how to correct your information.
  

Additional Provider Help

Upcoming Webinar, Tuesday, May 25 at 12:00 pm
Register: NC Medicaid Managed Care: What Comes Next
About this webinar: The NC Medicaid Ombudsman is offering a free webinar to update advocates and partner agencies on the next steps in the NC Medicaid Managed Care rollout, with a focus on what people with Medicaid should expect next and how the Ombudsman can help those people navigate this huge change to ensure they can access the care they need. Topics covered will include:

Enrollment issues - Auto Enrollment, Changing Plans, Requesting to Stay in Medicaid Direct

• Accessing Care - Transition of Care Protections, Care Management, Transportation Assistance
•  Updates - The Latest News on the Rollout and Ombudsman Services
• Q & A, and your chance to give us your feedback on this process so far.
  

NC AHEC has held a variety of webinars regarding Managed Care. Most recently, on May 6^th, they held a webinar on behavioral health in Standard Plans. You can view a recording and slides. For all previously recorded webinars by topic, visit, https://www.ncahec.net/medicaid-managed-care/