Archive | NC Medicaid

The NC Medicaid Program has issued updated guidance on the Advanced Medical Home Program designed to provide additional guardrails to assist primary care practices. The guidance can be found here. Key provisions include: • Pre-Paid Health plans cannot downgrade practices certified as AMH Tier 3 for any reason until 90 days after the Medicaid Managed […]

NC DHHS announced in early October that it has expanded the regions awarded to Carolina Complete Health Inc. (CCH) under the state’s transition to Medicaid managed care. In addition to serving Regions 3 and 5, Carolina Complete Health will also serve Region 4 that includes Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, […]

Effective Wednesday (10/2/2019), Medicaid Managed Care’s Enrollment Broker Provider Directory no longer supports searching for providers by specialty. DHHS has elected to remove the “Select a provider specialty” feature from both the “Find a primary care provider” page and from the “Filter by” page. Users must now search for a practice by geographic location and/or […]

DHHS has set a contracting deadline of Friday, November 15th for all physicians and practices wishing to serve Medicaid patients under managed care and be auto-assigned patients who do not actively choose their primary care provider. Family physicians and practices who do not contract with health plans by this deadline risk losing patients, as health […]

NC DHHS announced earlier this week that the first round of updates to Medicaid’s Enrollment Broker Provider Directory are now in place. The directory’s search function now returns only primary care providers and helps searchers more easily locate primary care physicians by their location, business, or organization name as listed in NCTracks. Additional improvements are […]

Primary care physicians serving Medicaid with E&M codes ranging from 99201 to 99499 as defined by the Affordable Care Act (ACA) are now being paid at an increased rate. CMS approved the rate increase effective Jan. 1st, 2019, thanks to the advocacy efforts of the NCAFP and the NC Pediatric Society. NC DHHS is re-processing […]

DHHS announced earlier this week that it will delay the go-live date of Medicaid managed care to February 1st, 2020, due to the state budget situation which is preventing the Department from completing critical startup functions. The newly adjusted timeline only affects counties in Phase 1 that were previously scheduled to begin November 1st. Medicaid […]

Academy Past President Shannon Dowler, MD (’13) has been named the new incoming Chief Medical Officer for the North Carolina Division of Health Benefits/North Carolina Medicaid. Dr. Dowler has a long history of service in leadership roles in North Carolina. Professionally, she most recently served as the Chief of Community Medicine and Ambulatory Population Health […]

North Carolina Medicaid has issued a series of questions and answers regarding concerns about the provider directory being used by the enrollment broker for Medicaid Managed Care. The Department has developed a document to answer several of these concerns that can be downloaded here.