July Provider Digest
AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. A Known System Issues Tracker Opens a new window is updated weekly and also available in NaviNet to providers.
You will find the following topics in this July digest:
MEMBER BENEFITS SPOTLIGHT
SAVING TIME
- Claims Investigations Attachments Now Available Via Navinet
- Primary Care Provider Change Request Form Is Live
NCDHHS UPDATES
- Care Management Rate Bulletin Released
- Home Health Electronic Visit Verification Required as of October 1
- Tobacco-Related Policy Requirements Delayed to January 1, 2027
QUALITY CORNER
- Post-Appointment Survey Provider Scorecard Available in NaviNet
- Clinical Leadership Forum: Value-Based Care Programs Overview
CLAIMS AND BILLING
STAKEHOLDER TRAINING OPPORTUNITIES
- Tobacco Cessation — Member Quit for Life Info Session
- Disaster Preparedness Webinar to Support Members With Chronic Conditions
MEMBER BENEFITS SPOTLIGHT
New Transportation Vendor
ACNC has a new vendor for member transportation across the state. Medical Transportation Management (MTM) will be providing non-emergency medical transportation (NEMT) as of August 1, 2025. The telephone number for transportation services has not changed. Providers can connect with our Member and Provider Transportation Services Call Center at 1-833-498-2262 to request support for members needing transportation.
Partnering with state and county governments, managed care organizations, health systems, and other programs, MTM serves disabled, underserved, and older adult populations. They use technology and a client-focused approach to pursue improved health outcomes, foster independence, and reduce healthcare costs.
Suspension of Healthy Opportunities Pilot
As of July 1, the Health Opportunities Pilot (HOP) was suspended by the NCDHHS due to a lack of funding in the proposed House and Senate budgets put forward by the North Carolina General Assembly. ACNC will make payments for any HOP services provided to members prior to June 30. Our Member Services and Care Management teams will continue to use NC CARE 360 as a resource to point members to who have needs that were previously supported by the HOP program.
SAVING TIME
Claims Investigations Attachments Now Available Via Navinet
Providers can now upload supporting documents with an electronic claim investigation request within the NaviNet provider portal! This enhancement is designed to streamline your workflow by eliminating the need to complete forms and send supporting documentation by fax or mail. Each supporting document will need to be no larger than 32 MB and saved in one of the following formats: docx, .pdf, .png or .gif. For a walk-through of the process, log into the portal and view the claims investigation training video.
Primary Care Provider Change Request Form Is Live
If your practice has a member who wishes to make your practice their PCP, visit the Provider Manuals, Policies and Forms webpage. At the bottom of the page, under the heading Provider change, find the English form (PDF) for submission. The form includes the propr fax number for notifying ACNC about the request to update a members’ primary care provider.
NCDHHS UPDATES
Care Management Rate Bulletin Released
Effective July 1, 2025, the North Carolina Department of Health and Human Services (NCDHHS) released its annual Care Management rates for FY 2026. Please see bulletin link (PDF) for details.
Home Health Electronic Visit Verification Required October 1
Per guidance from the NCDHHS, Electronic Verification Visit (EVV) is required as of October 1, 2025, for Home Health Care Services (HHCS) providers who offer the following services: Home health aide services, physical therapy, occupational therapy, speech therapy, and skilled nursing visits. As a reminder, claims submitted without the required EVV criteria will be denied. Providers can locate Service Codes Crosswalk with HCPCS (PDF) and Revenue Codes on the Home Health Electronic Visit Verification (EVV) webpage.
Tobacco-Related Policy Requirements Delayed to January 1, 2027
Tobacco-related policy requirements have been delayed until January 1, 2027, for NC Medicaid Managed Care Standard Plans, Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans, and Local Management Entity/Managed Care Organizations (LME/MCOs) contracted medical, behavioral health, I/DD and traumatic brain injury (TBI) service providers. Find additional information in the June 10, 2025, North Carolina Department of Health and Human Services (NCDHHS) Bulletin.
QUALITY CORNER
Post-Appointment Survey Provider Scorecard Available in NaviNet
ACNC works in collaboration with our providers to help ensure that our members receive comprehensive, quality, and culturally responsive care. One of the tools we use to evaluate the member care experience is our Post-Appointment Member Satisfaction Survey. The graph below reflects overall provider performance from July 2024 through December 2024.
Providers can view their member satisfaction ratings through the Post-Appointment Survey Provider Scorecard, available in the NaviNet provider portal. To access this new feature, login to NaviNet, and navigate to Clinical Reports Inquiry > Report Selection > Post-Appointment Survey Provider Scorecard.
CLAIMS AND BILLING
NEW! Primary Care Providers Claims Adjustment Reason Code (CARC)
Effective Monday, July 7, 2025, ACNC has implemented a new CARC code 22 to offer more specific instructions on documentation needed to support denial code Z11. CARC code 22 will include the notice “This care may be covered by another payor per coordination of benefits.” We hope this update provides clarity for billing professionals in our network.
STAKEHOLDER TRAINING OPPORTUNITIES
Member Quit for Life Info Session
Quit For Life® can help individuals stop vaping, smoking, or chewing tobacco. While quitting can be tough and it may take more than one attempt to stop, the no-cost Quit For Life program could help. If you have a patient struggling with tobacco use, join us to learn about why quitting is so hard; the nicotine replacement therapies available to help; and what you can do to support a patient, friend or loved one. Register for the Thursday, August 7, 2025 webinar.
| Dates | Time |
|---|---|
| Thursday, August 7, 2025 | 1 p.m. ET |
Disaster Preparedness Webinar to Support Members with Chronic Conditions
North Carolina Area Health Education Center (AHEC) is offering a webinar focused on disaster preparedness for members with chronic conditions. It will be held Tuesday, August 19 from noon to 1 p.m. Registration is required.
This series will cover topics such as:
- Overview of disaster preparedness in North Carolina
- Understanding at-risk Medicaid populations
- General preparedness for high-risk members
- Condition-specific considerations
- Sheltering in place vs. evacuation
- Special considerations for populations with disabilities
- Behavioral health and substance use disorder preparedness
- Building resiliency and promoting equity