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Medicaid: More Information
FAQs - NCHC Changes - CONTINUED
6. Is the Medicaid Billing Guide being revised to reflect program changes?
The fall 2011 Basic Medicaid Billing Guide update will include a new section 12 specific to Health Choice. It will cover:
7. Will NCHC recipients receive revised ID cards or a new Handbook?
NCHC recipients will get new ID cards effective Oct. 1, 2011. Current recipients will receive new cards in September.
Cards will include assigned PCP name and contact information. Recipient IDs will be Medicaid ID numbers; no more BCBS ID numbers.
ID card is not proof of eligibility; provider must verify. New joint Medicaid-NCHC Handbooks to be distributed in October. Handbooks will reflect benefits/program changes.
8. Why are the co-payments changing?
The co-payment changes were legislated by the North Carolina General Assembly. Not all families will have a change in their co-payment amount. Families should review their child’s current NCHC ID card and the notice they received in the mail to determine if the co-payment changes apply to them.
9. Who should I contact with questions about the co-payment changes?
For questions about any changes to co-payments, contact the DHHS Customer Care Service Center at 1-800-662-7030.
10. Will providers know about the new co-payment amounts?
NCHC providers have been notified of the changes in co-payments effective in the September Medicaid Bulletin. However, it is important that families take their child’s current NCHC ID card along with any notices they received, so that the provider knows what co-payments apply to them.
11. How will override procedures work for NCHC in the CCNC/CA?
Overrides will mirror the policy and procedures for Medicaid recipients enrolled in CCNC/CA.
That means an override request for past dates of service (after 10/1) should be submitted to HP on the override request form that is posted on the web.
Overrides are usually granted when a course of treatment was begun before enrolling in CCNC/CA, but it is not an automatic override and each situation is reviewed separately.
Continuity of care is important. For current or future dates of service, the provider contacts DMA override coordinator to request the override.
A provider requesting an override must contact the PCP for authorization before an override will be approved (unless this is the first time for enrollment of course).
Most PCPs are already enrolled in Medicaid and in CCNC so these situations would probably be few.
If a child is not established with their PCP within the first 3 months of enrollment, an override will be granted.
If the child is not established during that time period the request will be reviewed on an individual basis.
12. What has changed in the NCHC optical coverage?
NCHC covers a routine eye exam once every 12 months.
13. When can a NCHC child get eyeglasses?
NCHC covers eyeglasses (frame and lenses) once every 12 months.
NCHC covers medically necessary contact lenses and back-up eyeglasses once every 12 months.
14. Who should families contact with any questions about a child’s eligibility?
Families should call their county DSS caseworker or the DHHS Customer Service Center at 1-800-662-7030.
What are some resources we can refer recipient and providers to for assistance with NCHC issues:
Clinical Coverage Policies
http://www.ncdhhs.gov/dma/hcmp/index.htm
What’s New in DMA
For updates on transition changes and enrollment information
http://www.ncdhhs.gov/dma/provider/index.htm
NC Healthy Start Foundation
For NCHC application and eligibility information http://www.nchealthystart.org/
Fee Schedules
What NCHC pays
Medicaid/Medicare News
FAQs - NCHC Changes - CONTINUED
6. Is the Medicaid Billing Guide being revised to reflect program changes?
The fall 2011 Basic Medicaid Billing Guide update will include a new section 12 specific to Health Choice. It will cover:
7. Will NCHC recipients receive revised ID cards or a new Handbook?
NCHC recipients will get new ID cards effective Oct. 1, 2011. Current recipients will receive new cards in September.
Cards will include assigned PCP name and contact information. Recipient IDs will be Medicaid ID numbers; no more BCBS ID numbers.
ID card is not proof of eligibility; provider must verify. New joint Medicaid-NCHC Handbooks to be distributed in October. Handbooks will reflect benefits/program changes.
8. Why are the co-payments changing?
The co-payment changes were legislated by the North Carolina General Assembly. Not all families will have a change in their co-payment amount. Families should review their child’s current NCHC ID card and the notice they received in the mail to determine if the co-payment changes apply to them.
9. Who should I contact with questions about the co-payment changes?
For questions about any changes to co-payments, contact the DHHS Customer Care Service Center at 1-800-662-7030.
10. Will providers know about the new co-payment amounts?
NCHC providers have been notified of the changes in co-payments effective in the September Medicaid Bulletin. However, it is important that families take their child’s current NCHC ID card along with any notices they received, so that the provider knows what co-payments apply to them.
11. How will override procedures work for NCHC in the CCNC/CA?
Overrides will mirror the policy and procedures for Medicaid recipients enrolled in CCNC/CA.
That means an override request for past dates of service (after 10/1) should be submitted to HP on the override request form that is posted on the web.
Overrides are usually granted when a course of treatment was begun before enrolling in CCNC/CA, but it is not an automatic override and each situation is reviewed separately.
Continuity of care is important. For current or future dates of service, the provider contacts DMA override coordinator to request the override.
A provider requesting an override must contact the PCP for authorization before an override will be approved (unless this is the first time for enrollment of course).
Most PCPs are already enrolled in Medicaid and in CCNC so these situations would probably be few.
If a child is not established with their PCP within the first 3 months of enrollment, an override will be granted.
If the child is not established during that time period the request will be reviewed on an individual basis.
12. What has changed in the NCHC optical coverage?
NCHC covers a routine eye exam once every 12 months.
13. When can a NCHC child get eyeglasses?
NCHC covers eyeglasses (frame and lenses) once every 12 months.
NCHC covers medically necessary contact lenses and back-up eyeglasses once every 12 months.
14. Who should families contact with any questions about a child’s eligibility?
Families should call their county DSS caseworker or the DHHS Customer Service Center at 1-800-662-7030.
What are some resources we can refer recipient and providers to for assistance with NCHC issues:
Clinical Coverage Policies
http://www.ncdhhs.gov/dma/hcmp/index.htm
What’s New in DMA
For updates on transition changes and enrollment information
http://www.ncdhhs.gov/dma/provider/index.htm
NC Healthy Start Foundation
For NCHC application and eligibility information http://www.nchealthystart.org/
Fee Schedules
What NCHC pays
Medicaid/Medicare News
North Carolina Psychiatric Association - NCPA