North Carolina Medicaid providers are in the early days of the State's new Medicaid Managed Care program. Following its July 2021 launch, providers must now contract with multiple prepaid health plans (PHPs), each with its own staff, policies, procedures and rates. Disputes and mistakes are inevitable as PHPs and providers adapt to these new systems and navigating those disputes with private PHP contractors will be very different from past disputes with the State.

This program explores some likely areas of controversy and helps providers anticipate problems and plan to resolve them effectively.

Review the timeline of the transition to and implementation of Medicaid Managed Care in North Carolina, and explore common issues in PHP-provider network contracting, and likely areas where providers may have difficulty. This presentation discusses a potential for PHP-provider disputes, dispute resolution, and factors that may influence disputes and PHP networks.

Topics include rates, key contract terms, dispute resolution procedures, claim denials, member and provider appeals, and factors that may influence contracting and the resolution of disputes.

CLE:
APPROVED CREDIT
North Carolina: 1.00 MCLE Hour

*Please note there is a cost to attend this program