NOTE: NEW COMMUNITY EVENT POSTED BELOW

This webpage is designed to alert providers to up-to-date information from the State regarding Medicaid Transformation. To assist with a smooth transition, Alliance is encouraging its providers to become familiar with Medicaid Transformation and what it means for our members. This page will be updated with new information as it comes in so it is highly recommended that you check back here and the DHHS Medicaid Transformation website for regular updates.

Alliance will also provide updated information in the Provider News Service. Providers can sign up for and see the most recent newsletter.

NC’s plan for Medicaid Transformation will embody whole person care. This involves providing services and supports for a member’s physical, pharmaceutical, behavioral and social determinant needs. There will be two separate identified plans – Standard Plans and Tailored Plans.

What is a Standard Plan?

Individuals who are considered to be in the mild-to-moderate range regarding mental health/substance use symptoms and need support for those needs. (See below under “Tailored Plan” to see which services will be under the Standard Plans.)

Four statewide and one regional Standard Plans will operate in North Carolina:

AmeriHealth Caritas North Carolina, Inc.
Sheryl Swanson – BH/IDD Provider Network Consultant – (717) 514-5250
Sheron Rankins – Corporate Director Provider Network Management – (704) 437-4101
Katey Weaver – Corporate Population Health (integrated BH/PH management) – (717) 497-9564

Blue Cross and Blue Shield of North Carolina
Health Blue Network Development – (844) 415-2045
Network Development Representatives are available to assist providers Monday through Friday 8:00am-5:00pm ET.

United Healthcare of North Carolina, Inc. (Optum)
Provider Relations Team main contact for NC:
Amy S. Rice – Director of Behavioral Network Services
[email protected] – (813) 877-6829

Additional links on finding online resources, including how to contact the NC Provider Relations Team, can be found at:
www.providerexpress.com/content/ope-provexpr/us/en/our-network.html
www.providerexpress.com/content/ope-provexpr/us/en/contact-us/nmContacts/nc.html

Wellcare of North Carolina, Inc.
Jason A. Young MS – Sr. Manager, National Network Management, Behavioral Health
[email protected]care.com – (813) 206-4056
Claudia Phillips – National Network Management Specialist, BH
[email protected] – (312) 833-2748

Carolina Complete Care (Cumberland County only)
Betsey Hamburger – [email protected] – (919) 719-4161

All providers: approved PHP provider contract templates as of May 31, 2019. Visit this website for information on the contracts that have been approved for the Standard Plans.

What is a Tailored Plan?

North Carolina will launch specialized managed care plans, called BH I/DD Tailored Plans, starting in 2021. These plans are designed for those with significant behavioral health (BH) needs and intellectual/developmental disabilities (I/DDs). BH I/DD Tailored Plans will also serve other special populations, including Innovations and traumatic brain injury (TBI) waiver enrollees and waitlist members. Often this is called the “high risk” population.

These tables show the breakdown of services covered by the Standard Plan (SP), Tailored Plan and both:

The Tailored Plan will be operated by Alliance Health within our catchment area. The NC DHHS website is a great source of information regarding the transformation:

Comprehensive paper from NC DHHS detailing current Tailored Plan

Behavioral Health I/DD Tailored Plan

Medicaid Transformation Timeline

  • Aug. 2018 – DHHS released Standard Plan RFP
  • Feb. 2019 – DHHS awarded Standard Plan contracts
  • Nov. 2019 – Standard Plans launch in Phase 1 regions
  • Feb. 2020 – Standard Plans launch in Phase 2 regions
  • Mid-year 2020 – Tailored Plan readiness reviews (projected)
  • Tailored Plan go-live – July 2021

Community Events

Community Meeting for physicians, providers and community agencies to provide updated information on managed care, answer questions and obtain feedback on the launch of Medicaid Managed Care. Representatives from the Medicaid Managed Care Health Plans and the Enrollment Broker will be available. Register here.

Monday, August 26, 2019
7:30 a.m. Physician Session (physician assistants, nurses and practice office managers are also welcome)
10:30 a.m. Providers and Community Agencies Session (health care professionals and other interested individuals are encouraged to attend this session)

Guilford Technical Community College, Jamestown Campus

Resources and Links

NC Medicaid Provider Playbook – DHHS online resource to assist providers in helping their Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.

New resources will be added to the Provider Playbook as they become available. For technical issues identified during open enrollment, please email [email protected] or call (919) 527-7460.

NC Medicaid: County Playbook  – DHHS is providing county partners with resources to help Medicaid beneficiaries smoothly transition to managed care. This webpage is the “County Playbook,” a place where general and detailed information will be stored to help support North Carolina’s transformation to Medicaid Managed Care. The County Playbook will grow over time, with new documents added as soon as they are available. 

NC Medicaid Fact Sheet #6: Managed Care Populations and Enrollment Notices

DHHS Current and Past Trainings and Recorded Webinars

General NC DHHS Medicaid Transformation Information

NC DHHS Policy Papers – up-to-date documents outlining policies regarding Medicaid Transformation

Supporting Provider Transition to Medicaid Transformation

Guidelines around “Provider Rate Floor and Reimbursement Scenarios

Contact your Alliance Provider Network Specialist. Find out your Specialist here.

HAVE QUESTIONS?

Questions can be submitted to [email protected]. As Alliance gathers questions there will be a frequently asked question section added to this webpage.



Page last modified: August 15, 2019