08.27.2021: Information for providers supporting members disenrolling from UnitedHealthcare Medicaid Plan to Medicaid Direct
a. Some of the members may be disenrolled to Medicaid Direct for various reasons (e.g. placement in foster care or acquiring Medicare eligibility)
b. If this occurs for any members for which you are providing care/services, you should check NC Tracks (https://www.nctracks.nc.gov/content/public/) to verify the member’s current eligibility and enrollment status prior to submitting a new prior-authorization request or continuation of an existing prior-authorization request.
c. Because of time-limited flexibilities regarding prior authorization processes, there may be scenarios where an existing authorized service is not transferred to Medicaid Direct.
d. If services you are providing or plan to provide to a member requires prior authorization in Medicaid Direct and no prior-authorization information is on-file with Medicaid Direct, the provider may be required to submit a prior-authorization request to appropriate Medicaid Direct Utilization Management Vendor.
07.06.2021: CDSA – all providers including occupational therapy, speech therapy & physical therapy providers.
Due to the passage of SL 2021-62, effective July 1, 2021, the following services are carved out of NC Medicaid Managed Care and should continue to be billed through NCTracks:
Services documented in an individualized family service plan (IFSP) that are provided and billed by a Children’s Developmental Services Agency (CDSA)
Services documented in an IFSP that are provided and billed by a provider contracted with a CDSA to provide those services.
CDSAs and independent practitioner providers providing IFSP services for the CDSA should hold their claims from July 1, 2021, through July 12, 2021, for dates of service starting on July 1, 2021.
Starting on July 13, 2021, CDSAs and independent practitioner providers providing IFSP services for the CDSA may submit their claims to NCTracks for all IFSP services for dates of service starting on July 1, 2021. These claims must be submitted to NCTracks with a TL modifier.
07.06.2021: Vaccine – to all PCP’s & Behavioral health
North Carolina DHHS has released vaccine counseling code 99401 as a covered code. UnitedHealthcare is in process of adding 99401 as a covered code which will become effective in our system on July 11, 2021. In the interim, claims will pend to ensure claims are processed correctly after system configuration.
Per North Carolina DHHS SPECIAL BULLETIN COVID-19 #168: Vaccination Counseling Code Reimbursement, effective 6/22/21 providers must bill CPT 99401 with a CR modifier and there is no requirement for a specific diagnosis code.
Targeted Case Management & Care Management Duplication Statement UnitedHealthcare is committed to the health and well-being of all our members and in doing so offers care management support for members needing support managing chronic conditions, linking to social supports and/or otherwise needing support accessing certain benefits. Certain members fall within certain priority populations (e.g. members with HIV) and receive care management outreach either through UnitedHealthcare staff or staff within delegated care management entities such as Tier 3 Advanced Medical Homes, Clinical Integrated Networks or Local Health Departments. In review of the HIV Targeted Case Management service description and Clinical Coverage Policy, it was determined that the service closely mirrors the care management requirements established by the North Carolina Department of Health Benefits for members enrolled in the Standard Plans and providing both required care management supports as well as HIV Targeted Case Management would be duplicative and cause unnecessary member confusion and abrasion. As such, the case management services and supports available through UnitedHealthcare and the delegated case management entities will be the mechanism available to members with HIV/AIDS rather than the separate service of HIV Targeted Case Management.