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NC MEDICAIDVIRTUAL OFFICE HOURSDental Care Under MedicaidTransformation/Managed CareDarlene P. Baker, RDH - Lead Dental Policy AnalystMark Casey, DDS, MPH - Dental DirectorSeptember 24, 2019
Content Managed Care Launch Service Carve Out Managed Care Legislation Medicaid Direct Prior Approval and Billing Clinical Coverage Policies Beneficiary Resources PHPs and Contact Information Value Added Service (VAS) Provider Resources QuestionsVirtual Office Hours Dental Coverage September 20192
PREVIOUSLY SUBMITTEDQUESTIONSPLEASE ENTER ALL QUESTIONS INTO THE CHATBOX AND SENDONLY TO:AADMIN FOR QUESTIONS -Virtual Office Hours Dental Coverage September 20193
Managed Care Launch – February 1 ,2020MAP - PHP RegionsRegion MBECATAWBAJACKSONMACONROWANPOLKCLEVELANDRegion INSTOKESALAMANCERegion 1Region 6ALLEGHANYGRANVILLEASHERegion MBUSRegion 5BRUNSWICK234562017 07 10Virtual Office Hours Dental Coverage September 20194
Service Carve-OutDental Services areEXCLUDED fromManaged Careand Capitation.Per the North Carolina General Assembly,Dental Services are carved out and remainfee-for-service (FFS).VIRTUAL OFFICE HOURS DENTAL COVERAGE SEPTEMBER 20195
Session Law 2015-245/House Bill 372Services covered by PHPs – Capitated PHP contracts shall coverall Medicaid and NC Health Choice services, including physicalhealth services, prescription drugs, long-term services andsupports, and behavioral health services for NC Health Choicerecipients, except as otherwise provided in this subdivision.Behavioral health services for Medicaid recipients currentlycovered by the local management entities/managed careorganizations (LME/MCOs) shall be excluded from the capitatedcontracts until four years after the date capitated contractsbegin. The capitated contracts required by this subdivision shallnot cover dental services.Virtual Office Hours Dental Coverage September 20196
Medicaid Direct Traditional Fee for Service (FFS) Medicaid NC Medicaid and Health Choice Dental Services NC Medicaid and Health Choice Orthodontic ServicesVirtual Office Hours Dental Coverage September 20197
Prior Approval and BillingPrior Approval and claims submission remain the same forthe carved out Medicaid Direct Dental and OrthodonticServices.#1- Prior ApprovalProviders willcontinue to obtainprior approvalthrough NCTracksVirtual Office Hours Dental Coverage September 2019# 2 – ClaimProviders willcontinue to submit claimsthrough NCTracks andreceive payment throughthe Medicaid Checkwrite8
Clinical Coverage Policies for Children and Adults4A Dental ServicesBeneficiaries (children and 4A 0.pdf4B Orthodontic ServicesBeneficiaries Under 21 Years of Agehttps://files.nc.gov/ncdma/documents/files/4B 0.pdfVirtual Office Hours Dental Coverage September 20199
Beneficiary ResourcesYOU are a Great Resource For Your Medicaid andHealth Choice Beneficiaries Enrollment – Enrollment Broker at (833) 870-5500 Medicaid Contact Center at (888) 245-0179 Local County Department of Social Services https://medicaid.ncdhhs.gov/medicaidVirtual Office Hours Dental Coverage September 201910
PHPs and Contact InformationAmeriHealth Caritas North om(844) 399-0474Carolina Complete Health * Only in Regions 3 and 5networkrelations@cch-network.com(919) ue.com(844) 415-2045Virtual Office Hours Dental Coverage September 201911
PHPs and Contact (866) 686-9332WellCare of North Carolinanetworkexpansion@wellcare.com(855) 599-3814Virtual Office Hours Dental Coverage September 201912
Value Added ServiceValue Added Service (VAS) PHPs may offer State approved additional coveragebeyond the ‘floor’ services outlined in currentMedicaid clinical coverage policies. A VAS is offered as a bonus to enhance care andattract members to the PHP’s network.Virtual Office Hours Dental Coverage September 201913
Provider Resources Medicaid Contact Center at (888) 245-0179 Medicaid.Transformation@dhhs.nc.govMedicaid NCTracks Call Center at (800) 688-6696 Provider Playbook: Medicaid Managed playbook-medicaid-managed-careVirtual Office Hours Dental Coverage September 201914
Your Live Questions AnsweredPLEASE ENTER ALL QUESTIONS INTO THE CHATBOX AND SENDONLY TO:AADMIN FOR QUESTIONS --Virtual Office Hours Dental Coverage September 201915
ResourcesOpportunities for EngagementDHHS values input and feedback and is making sure stakeholders have the opportunity toconnect through a number of venues and activities.Ways to ParticipateRegular webinars, conference calls, meetings, and conferencesComments on periodic white papers, FAQs, and otherpublicationsRegular updates to -transformationComments, questions, and feedback are all very welcome atMedicaid.Transformation@dhhs.nc.govProvider Resources: https://Medicaid.ncdhhs.gov/providersProviders will receive education and supportduring and after the transition to managed care.VIRTUAL OFFICE HOURS DENTAL COVERAGE SEPTEMBER 2019*PLEASE SEND ALL QUESTIONS IN THE CHATBOX TO: AADMIN FOR QUESTIONS -- *16
ResourcesUpcoming EventsManaged Care PublicationsQuestions and Answers: Provider Specific Questions General Provider Frequently Asked QuestionsReadiness Resources: Non-Emergency Medical Transportation Searching the Enrollment Broker ProviderDirectory, September 2018 Overview of the Beneficiary Experience in NCMedicaid Managed Care for Medicaid Providers Medicaid Transformation: Overview Medicaid Transformation: Beneficiary Enrollmentand TimelinesOther Upcoming EventsVirtual Office Hours Sessions: LTSS (Long-Term Services and SupportOverview)Tuesday, Oct. 15, 2019 from 12-1 p.m. Provider reviews, audits andinvestigations in Managed CareTuesday, Nov. 12, 2019 from 12-1 p.m. Provider/PHP Meet and Greets:beginning April 2019Look out for more information on upcoming events and webinars distributed regularly through special provider ovider-playbook-medicaid-managed-careVIRTUAL OFFICE HOURS DENTAL COVERAGE SEPTEMBER 201917
Future Webinar Topics Oversight of the AMH (Advanced Medical Home)Program Approach to AMH (Advanced Medical Home) DataSharing (Two webinars: 101 and 102) Quality Measurement and Performance Incentives inthe AMH (Advanced Medical Home) Program Priority Updates to the State’s VBP (Value BasedPayment) Roadmap “Deep Dive” on Avoidable Utilization Quality Measure “Deep Dive” on Low-Birthweight Quality Measure Introduction to the Healthy Opportunities PilotsVirtual Office Hours Dental Coverage September 201918
Provider Playbook ResourcesDocument Title/TopicDocument TypeIntroduction to Medicaid Transformation: Part 1 - OverviewFact SheetIntroduction to Medicaid Transformation: Part 2 - BeneficiaryEnrollment & TimelinesFact SheetNEMT (Non-Emergency Medical Transportation)Contracting and Quality Determination for a ProviderDeemed Eligible Process for Newborns: What Providers Need toKnowFact SheetFact SheetFact SheetManaged Care Populations and Enrollment NoticesSample Enrollment Notices/Outreach MaterialsGrievances and Appeals: MembersGrievances and Appeals: ProvidersCare ManagementPanel ManagementReadiness Assessment (Part 1): Provider POV (Point of View)Fact SheetActualsFact SheetFact SheetFact SheetFact SheetDiscussionGuide/ChecklistFact SheetFact SheetFact SheetFact SheetCare ManagementQualityFraud, Waste and AbuseHealthy OpportunitiesVirtual Office Hours Dental Coverage September 201919
PLEASE C0NTINUE TO SENDALL QUESTIONS IN THECHATBOX TO:AADMIN FOR QUESTIONS --Virtual Office Hours Dental Coverage September 201920
THANK YOU FOR JOINING THEVIRTUAL OFFICE HOURSDISCUSSION!Virtual Office Hours Dental Coverage September 201921
Dental Care Under Medicaid Transformation/Managed Care Darlene P. Baker, RDH - Lead Dental Policy Analyst Mark Casey, DDS, MPH - Dental Director September 24, 2019 . CLAY GRAHAM SWAIN MACON JACKSON TRANSYLVANIA HAYWOOD HENDERSON BUN
