NCMS Morning Rounds 5-20-21

Happy Thursday! Enjoy your NCMS Morning Rounds.

May 20, 2021

Getting Ready for Medicaid Managed Care

The NC Department of Health and Human Services (NCDHHS) extended the deadline for open enrollment until tomorrow, Friday, May 21 as the state prepares to ‘go live’ with Medicaid managed care as of July 1.

As with any major change, there are sure to be things that do not go according to plan, and the NCMS, along with other physician and PA organizations, is thinking through how we can help our members deal with this momentous shift in how services will be delivered to patients covered by Medicaid. To that end, we are developing tips as well as a special troubleshooting process where you can log your issues with us. The purpose is to aggregate common challenges so we can communicate what issues many members are encountering with the state and with our contacts at each health plan. We have a better case to make with officials if we can show large numbers of practices are experiencing the same type of problem.

We also will compile and share tips and resources on how to make the most of the changes for you and your patients.

Stay tuned to your NCMS Morning Rounds and your email for updates on the process to log your issues with us and how we will go about resolving them. The NCMS is your partner in helping to ensure you can provide the highest quality care to your patients.

In the meantime, NCDHHS continues its series of webinars about various aspects of the transition to Medicaid managed care. Information and presentations from previous webinars are available here, as well as a schedule of upcoming webinars and events.

Prior Authorization Requirement Changes

On Sept. 1, 2021, Blue Cross NC prior authorization requirements will change for Healthy Blue + Medicare members covered by Blue Cross NC. Federal and state law, as well as state contract language and the Centers for Medicare and Medicaid Services (CMS) guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage.

Learn what codes prior authorization requirements will be added to here.

Our Legislative Relations Team Needs Your Input!

Legislators on the NC Senate Health Committee are engaged in robust discussion on HB 395 – HIE Deadline Extension and Patient Protection this week. To offer them some additional insight into whether or not you are connected to the NC Health Information Exchange (NC HealthConnex), we would like to hear from you. Please take just a minute to answer four questions about NC HealthConnex.

Take the Survey

In the News

COVID-19 Vaccine Trials Underway For Kids 5 And Younger, NPR, 5-17-21

Learning Opportunity

Medicaid Managed Care for Hearing and Vision Services, THURSDAY, MAY 27 | 4-5 PM
Medicaid Transformation Provider Services and North Carolina AHEC are conducting a series of Virtual Office Hours for providers. These sessions offer an interactive format for providers to have their questions answered.

Register here.

If you have policies you’d like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!

 

 
 

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