Medicaid Managed Care started on July 1, 2021 which means approximately 1.6 million Medicaid beneficiaries in North Carolina are now members of one of the 5 Prepaid Health Plans, AmeriHealth Caritas, Carolina Complete Health Network, Healthy Blue, United HealthCare Community Plan, and WellCare.
What are the timelines?
DHHS resumed implementation of Managed Care to go-live on July 1, 2021 for Standard Plans.
Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022.
Aug. 1, 2021 – Beneficiaries have 30 days to change their AMH/PCP without cause (1st instance) and shall be allowed to change their AMH/PCP without cause up to one time per year thereafter (2nd instance). In addition, Members shall be allowed to change their AMH/PCP with cause at any time.
Aug. 30, 2021 – Last date by which the health plan will pay claims and authorize services for Medicaid-enrolled out-of-network providers equal to that of in-network providers (or until end of episode of care, whichever is less)
Sept. 29, 2021 – Last date by which the health plan must honor existing and active prior authorizations on file with the North Carolina Medicaid or NC Health Choice program (or until the end of the authorization period, whichever occurs first)
Sept. 30, 2021 – End of beneficiary choice period.
https://medicaid.ncdhhs.gov/providers/provider-playbook-medicaid-managed-care
Important Numbers:
NCTracks Call Center: 800-688-6696
Call the health plan for coverage, benefits and payment questions.
- AmeriHealth Caritas: 888-738-0004
- Carolina Complete: 833-522-3876
- Healthy Blue: 844-594-5072
- United Healthcare: 800-638-3302
- WellCare: 866-799-5318
Maximus: Phone: 1-833-870-5500 (TTY: 711 or RelayNC.com)
Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday
Contact the provider Ombudsman on unresolved problems or concerns.
- Provider Ombudsman: 866-304-7062
How can CCLCF help?
CCLCF is excited to continue providing practice support and personalized care management services to our partners in Medicaid Managed Care. We work with Pre-paid Health Plans, ACO’s, practices and providers to deliver cooperative coordinated care, ensure consistent quality services, provide medically appropriate services, and establish cost-effective health care services.
We offer AMH Tier 3 services including:
- An AMH data integration system including data integration, risk stratification, data analytics, and Health Plan reporting
- Local, interdisciplinary Care Management support – ask us about our boots on the ground approach for almost 18 years in southeastern, NC!
- Care Coordination and Social Determinants of Health support
- Practice Support – helping practices understand PHP quality incentive plans, AMH quality measures, Value Based Payment arrangements, and helping to build your practice’s capacity to offer and bill for screenings – increasing revenue and patient satisfaction.