This guide provides need-to-know information regarding the provider portal, securing prior authorizations, important phone numbers, and more!
This document provides timely information related to known issues impacting providers. This will be updated weekly on Thursdays.
Previously, Carolina Complete Health (CCH) has required authorization for behavioral health (BH) outpatient therapy after members utilized 24 sessions. Beginning on 09/12/2023, Carolina Complete Health removed the prior authorization requirement for BH outpatient therapy. These therapy codes include 90832, 90834, 90837, 90846, 90847, 90849, and 90853. In order to ensure appropriate utilization without prior authorization requirements, CCH will monitor utilization trends across providers. Please read on for additional information regarding coding guidelines.
Carolina Complete Health follows NC Medicaid policy 8B for Inpatient Behavioral Health Services. The most recent update to this policy notes that there is no authorization required for the first 72 hours of a member’s Inpatient admission. Authorization is required if a member’s stay is beyond 72 hours.
In order for CCH to assist with discharge planning as needed, the request is for providers to submit a notice of admission within 48 hours of a member’s admission via the usual Prior Authorization form submission. You can use the PA form, found here, to submit notification.
Join the North Carolina Medical Society for LEAD 2023 and the Golden Stethoscope Awards Gala.
The North Carolina Medical Society is designing an exciting program filled with engaging educational topics and opportunities for fun and camaraderie, including the 2nd Annual Golden Stethoscope Awards Gala. This year celebrates the 20th Anniversary of Leadership College! Registration opens soon. Stay tuned for more information at ncms-lead.com.
At this year’s LEAD Conference, the only provider-led health plan in NC Medicaid, Carolina Complete Health (CCH) and the NCMS-owned company that works exclusively with CCH, Carolina Complete Health Network (CCHN), will hold a session on Friday afternoon to hear from clinicians who see patients with Medicaid coverage. We want to hear, in advance, about the issues clinicians think require top priority attention to make Medicaid more efficient and to improve results for those with Medicaid coverage. Please plan to attend. Please complete this FEEDBACK FORM to let us know what issues you think should be addressed. Our plan is to identify groups of clinicians to address each major issue and develop ideas for implementation. Thanks in advance for your participation.
A Message From NCTracks on Behalf of N.C. Medicaid:
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans) scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined. Beneficiaries who will be covered by the Tailored Plans will continue to receive care as they do today.
All Home Health Care providers are expected to be fully compliant with Electronic Visit Verification (EVV) requirements. HHCS claims with service date 10/01/2023 and forward must be submitted to Carolina Complete Health using EVV for payment otherwise payment will be denied per state mandate.
To prepare for this hard launch, HHCS providers are expected to use EVV effective immediately for home health visits.
During the extended soft launch timeframe:
Urgent Reminder: North Carolina Medicaid Providers should review the NC DHHS reverification due date list, and frequently check their Provider Message Inbox for notifications or the reverification section of the Status and Management page in the NCTracks Secure Portal. Failure to renew Medicaid eligibility or re-credential will result in claims denials. Expand for more information
Re-credentialing/reverification is an evaluation of a provider’s ongoing eligibility for continued participation in NC Medicaid, normally conducted every five years as mandated by the Affordable Care Act. However, the federal Public Health Emergency (PHE) paused reverification from March 2020 through May 11, 2023, delaying the due date for nearly 30,000 providers over that three-year period. Now that the federal PHE has ended, NC Medicaid must ensure that all enrolled providers, including those whose reverification was delayed, are compliant with the reverification requirement.
Reverification notifications are sent to the provider 70 days prior to the reverification due date, with reminders at 50 days, 20 days, and 5 days. Non-responsive providers then receive a notice of suspension which gives an additional 50 days to submit their reverification application before being terminated from the program. Including the notice of termination, and depending on the provider’s responsiveness, each will receive up to 6 targeted notifications over a 120-day period. If terminated, the provider may re-enroll at any time.
For convenience, NC Medicaid offers a list of “Active Provider Re-Verification Due – July 2023 – Dec 2023” dates (updated biannually). The reverification due date displayed is also the health plan suspension date of the provider record if no action is taken to submit the reverification application under the applicable NPI. If the health plan is suspended, claims payment will stop.
Providers are encouraged to review the reverification due date list, and frequently check their Provider Message Inbox for notifications or the reverification section of the Status and Management page in the NCTracks Secure Portal for the option to reverify. In addition to the resources below, providers may contact the NCTracks Call Center at 800-688-6696 for assistance.
Failure to renew Medicaid eligibility or re-credential will result in claims denials.
Clinical Coverage Policies can be reviewed by our Medical Policy workgroups or by external specialists who are North Carolina Medicaid providers. As a direct result of physician feedback, revisions to medical policy are suggested to Carolina Complete Health's Medical Affairs Committee and discussed for implementation. While there may be times that CCH cannot make revisions to policy, feedback is ultimately shared with NC Department Health and Human Services for consideration. Please see below for important updates regarding Clinical Coverage Policies as a result of the June meeting of the MAC:
|Clinical Coverage Policy||Policy Update|
|Pancreas Transplantation Policy, NC.CP.MP.102||Recently, policy NC.CP.MP.102 (Pancreas Transplantation) was revised based on review and feedback from specialists in the Carolina Complete Health provider network. The policy expands the medical necessity criteria for Pancreas Transplantation. See the revised policy here!
Effective date: 6/20/23
|Cerumen Removal Payment Policy||Based on feedback, the Cerumen Removal payment policy was retired for use.
Retired date: 6/20/23