Cliff notes for 2024 North Carolina Medicaid changes

The hardest part of credentialing and enrollment is staying on top of the ever-changing processes. Our expert team keeps up with changes by attending conferences, live talks, and Medicaid webinars, and getting newsletters from relevant associations and insurers.

Download the NCTracks Medicaid “Journey to Modernization” presentation here.

As busy healthcare leaders, you simply don’t have time to sift through packets of information or catch a Medicaid webinar during lunch.

We want the absolute best for you, so we’ve asked Teresa Faulconer, Credentialing and Enrollment Lead Representative to take what she learned during the NCTracks Medicaid Presentation in June 2023 and give us a bite-sized breakdown of the important changes with actionable insights.

Straight from Teresa’s own notes on the North Carolina Medicaid changes:

In 2017, Session Law 2017-57 authorized the replacement of current Medicaid Management Information System (MMIS) technologies with modular systems.

2 major benefits of the system change

1. NC Medicaid Managed Care Transformation Roadmap will

a. Ease the provider's administrative burden.

b. Modernize PDM/CVO technologies.

c. Simplify and enable responsive access for Medicaid providers to participate in NC’s Medicaid Program.

2. PDM/CVO will be operational in 2024 and will

a. Align with NC Medicaid Managed Care Transformation Roadmap.

b. Streamline data intake and maintenance throughout the provider lifecycle.

c. Perform provider enrollment and credentialing on behalf of NCDHHS.

d. Detect and prevent fraud, waste, and abuse.

e. Eliminate redundant entry of information.

f. One set of standards.

g. Online portal.

What does this mean for provider data management?

Provider Data Management Credentialing Verification Product Features will include

a. Provider Self-Service Portal

b. Internal Portal

c. Call Center

d. Administrative Functionality

e. Credentialing Verifications

f. Credentialing Committee

How will NCDHHS acquire, test, and implement the new PDM CVO module?

Stage 1 “Acquire”

• Define business-drive requirements and expected outcomes.
• Procure solutions from the vendor that provides the best value.

Stage 2 “Configure & Test”

• Coordinate with NC Medicaid providers to proactively communicate changes and solicit design input.
• The selected vendor will configure the module to meet NC Medicaid needs.
• Solicit testing input from various provider communities.

Stage 3 “Implement”

• Upon implementing the PDM/CVO, all current recredentialing due dates will remain unchanged.
• The provider community will remain informed by way of webinars, arranging training, and frequent communications.
• Single Web-Based Application.

• Collects all the information needed to meet credentialing standards for all state programs at one time.
• Providers new user interface for electronic enrollment process
• Auto-populates information maintained in the PDM/CVO platform.
• Includes drop-down lists and lookups to populate data elements for valid pre-determined choices.
• Permits providers to continuously update information submitted through the PDM/CVO application.
• Helps providers track the status of their application for enrollment.
• Collaborates with PDM/CVO vendor to resolve issues relating to service, data integrity, complaints, etc.

Read the complete NCTracks Medicaid “Journey to Modernization” presentation here.

To help you and your staff navigate these changes, the NCDHHS will engage in provider-focused education and outreach to help providers transition from the current Medicaid provider enrollment process to the transition period processes and then to the entire centralized credentialing process under full implementation.

Communications will include provider association webinars, ongoing stakeholder meetings, training, and outreach to enrolled providers, prospective providers, associations, and stakeholders. Please visit the NCTracks Medicaid website for updates, and contact us with any questions.