NCMS Morning Rounds 7-9-21

T.G.I.F! Enjoy your NCMS Morning Rounds.

July 9, 2021

Kanof Institute for Physician Leadership Still Accepting Applications

The NCMS Foundation’s Kanof Institute for Physician Leadership (KIPL) is now accepting applications for its 2022 classes of scholars for its Leadership College and Health Care Leadership and Management programs.

If you would like to learn more about these programs, please submit an interest form (see below) or email Aubrey Cuthbertson at acuthbertson@ncmedsoc.org.

Learn more about the Kanof Institute for Physician Leadership and all its programs here.

Enrollment and Eligibility Updates Available in NCTracks

Effective July 1, 2021, enrollment and eligibility data was added to NCTracks for managed care (MC). The added information will allow authorized users to search the following:

  • MC Prepaid Health Plan (PHP) provider name
  • MC PHP provider contact information
  • MC Advance Medical Home (AMH) and primary care provider (PCP) name
  • MC AMH and PCP contact information

In addition to the changes made in the NCTracks portal, the corresponding 270/271 companion guide (located on the Trading Partner Information page) has been updated to reflect the additional information. Trading partners and providers are encouraged to review these important updates.

Prepaid Health Plan Flexibility for Prior Authorizations During First 60 days after Managed Care Launch

NCDHHS continued to receive feedback from NC Medicaid providers indicating confusion about prior authorization requirements during the state’s transition to NC Medicaid Managed Care. The Department shared this feedback with the prepaid health plans (PHPs). In response to these concerns, the PHPs will implement the following solution during the first 60 days after managed care launch to ensure beneficiaries continue to have access to services during this transition without unnecessary interruption.

  1. Between July 1 and Aug. 30, 2021, medically necessary services that normally require prior authorization will still be reimbursed at 100% of the NC Medicaid fee-for-service rate for both in- and out-of-network providers.  To ensure that providers fully understand each PHP’s prior authorization requirements during the transition, the PHPs will still process and pay for these services if:
    • a provider fails to submit prior authorization prior to the service being provided and submits prior authorization after the date of service, or
    • a provider submits for retroactive prior authorizations.
      This exception does not apply to concurrent reviews for inpatient hospitalizations which should still occur during this time period.
  2. Beginning Aug. 31, 2021, the PHP may deny payment for services that require prior authorization.  For in-network providers this will apply to those services that normally require prior authorization. Out-of-network providers will need to seek authorizations for all services.
  3. The Department expects all providers to maintain scheduled medical care for beneficiaries through this transition.
  4. The Department expects the PHPs and providers to continue to work to resolve any outstanding contracting barriers during this time to mitigate out-of-network challenges.

Additional details about each PHP’s required authorizations are available here:

In the News

Organ Donations Held Almost Steady During The Pandemic, As The U.S. Transplant System Scrambled To Keep Going, STAT, 7-7-21

Learning Opportunity

Training & Discussion on FQHC Reconciliation & Wraparound Process Under NC Medicaid Managed Care, Friday, July 16, 11:00 AM-12:30 PM

NCCHCA is partnering with NC Medicaid to host a training via Zoom for NCCHCA members on the FQHC Claims Reconciliation and Wraparound Process under Medicaid Managed Care. There is no cost to the training, and registration is now open.

Contact Brendan Riley for the registration link.

 

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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