NCMS Morning Rounds 7-14-21

Wonderful Wednesday! Enjoy your NCMS Morning Rounds.

July 14, 2021

NC Commission for Public Health

The NCMS has an opportunity to appoint a new member to the NC Commission for Public Health. The NC Commission for Public Health is the public health rulemaking body for North Carolina. The Commission is authorized and directed by the N.C. General Assembly to adopt rules to protect and promote the health of the public and to adopt rules necessary to implement public health programs administered by the Division of Public Health. The Commission for Public Health was first established by the N.C. General Assembly in 1877 as the State Board of Health. It was renamed the Commission for Health Services in 1973 and became the Commission for Public Health in 2007. The Division of Public Health is staff to the Commission.

The North Carolina General Assembly has invested the Commission for Public Health with statutory responsibilities to support the mission of the public health system, which is to promote and contribute to the highest level of health possible for the people of North Carolina.

View appointee criteria for appointment here. If interested, please complete application here and submit to Evan Simmons at ESimmons@ncmedsoc.org by Friday, July 30th.

Prepaid Health Plan Information Added to NCTracks Automated Voice Response System

As part of recent NC Medicaid Managed Care updates, NCTracks accepts beneficiary enrollment and eligibility inquiries through the Automated Voice Response System (AVRS) which can be reached at 800-723-4330. The AVRS response includes the Prepaid Health Plan (PHP) name, contact information and the PHP assigned Primary Care Provider (PCP)/Advanced Medical Home (AMH). The response also includes a reminder that all care must be coordinated through the PHP.

To obtain PHP information via the AVRS:

  1. Dial 800-723-4330
  2. Press 1 to identify yourself as a provider.
  3. Press 2 to request an eligibility inquiry.
  4. The system will ask for the NPI. Enter the NPI, then press 1 to confirm it if correct.
  5. Enter either a recipient ID or a recipient date of birth and social security number.
  6. Enter a date of service.

If the recipient is eligible for Medicaid Managed Care coverage, a message will play with the details of that plan.

Addition of Pharmacy Explanation of Benefits for Claims Denied for Managed Care Beneficiaries

Effective July 1, 2021, an Explanation of Benefits (EOB) was added to NCTracks for pharmacy claims: EOB 2093 – SUBMIT CLAIM TO THE PHP FOR SERVICES INCLUDED IN THE MANAGED CARE PLAN.

This EOB is received when a pharmacy claim is denied due to the beneficiary being enrolled in Medicaid Managed Care. When a claim is denied for this cause, NCTracks will send the name of the Managed Care Plan that beneficiary is enrolled with, as well as information related to submitting pharmacy claims to that Managed Care Plan, on the pharmacy claim response transaction.

Pharmacy claim response transactions will include one of the following messages (as applicable) on the claim denied with edit 2093:

  • AmeriHealth Caritas member: Bill to AMHC BIN 019595 PCN PRX00801
  • Carolina Complete member: Bill to CCHE BIN 004336 PCN MCAIDADV GRP RX5480
  • Healthy Blue member: Bill to BCBS BIN 020107 PCN NC GRP 8473
  • United Healthcare member: Bill to UNHC BIN 610494 PCN 4949 GRP ACUNC
  • WellCare member: Bill to WCHP BIN 004336 PCN MCAIDADV GRP RX8904

In the News

FDA Calls For Federal Investigation Into Its Controversial Alzheimer’s Drug Approval, STAT, 7-9-21

Learning Opportunity

NC Medicaid Managed Care Hot Topics Webinar: Managed Care Transition Highs and Lows Thursday, July 15, 2021, 5:30 PM ET

The Medicaid webinars on the first and third Thursday of each month are dedicated to bringing you late breaking information/guidance on NC Medicaid’s transition to NC Medicaid Managed Care. Topics will vary, but each session will include an open question and answer period.

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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