Provider Contracts Due to Health Plans by Nov. 15, 2019
November 7, 2019Medicaid North Carlonia has traditionally experienced high provider enrollment rates, which we want to continue. The November 15 deadline allows health plans to process provider contracts and ensure that providers can be paid; this typically takes at least two to three weeks, but it may take longer. Additional time is then needed to transmit information to the Department for inclusion in the auto-enrollment process.
PCPs who do not contract with health plans by November 15 risk losing patients, as health plans will enroll beneficiaries only with network providers. If a contract is not in place by Feb. 1, 2020, and the provider has not engaged in good faith negotiations, the provider is at risk for being reimbursed at 90% and subject to additional prior authorizations.
Health systems and providers are strongly encouraged to continue contract negotiations with health plans and finalize contracts as soon as possible. Once contracts are executed, health systems and providers become in-network providers with that health plan.
For more information on contracting with a health plan, contact them directly. Contact information is available on the Medicaid website at https://medicaid.ncdhhs.gov/health-plancontact-information.