North Carolina Medicaid Billing, Automated.
In North Carolina, home care providers serving Medicaid clients often struggle with the administrative demands of multiple systems, including two key EVV Aggregation systems—Sandata for direct state program participants and HHAeXchange for those with MCOs. These requirements bog down agencies with complex billing processes, hindering growth. Paradigm steps in to simplify: billing automation, EVV matching, client eligibility checks and more, save time and pave the way for growth.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinNorth Carolina.
Electronic Visit Verification
Despite clear opportunities, North Carolina's mix of systems and payers can be a confusing maze.
EVV Requirements
North Carolina operates under an open model, allowing providers the flexibility to select any EVV system they prefer, as long as it can integrate with the state's approved aggregators.
EVV Aggregators
North Carolina's EVV system depends on the payer: NCDHHS uses Sandata, while MCOs require HHAeXchange.
Billing Process
The method for submitting claims in North Carolina varies by payer. For NCDHHS, claims go through NCTracks, while MCOs use HHAeXchange.
Rates
The appeal for home care agencies in North Carolina is clear: Medicaid services not only provide competitive rates of $23 to $25 (on average) per hour but also offer the opportunity for a high volume of authorized hours per client.
It's important to note that with Managed Care Organizations (MCOs) in the picture, these rates may vary as contracts are negotiated individually with agencies. While the growth potential is significant, it's crucial for agencies to meticulously review MCO contracts.
Payers
State Program
The North Carolina Department of Health and Human Services (NCDHHS) administers the state’s Medicaid program, ensuring comprehensive coverage for home care services.
Managed Care Organizations (MCOs)
In North Carolina, there are five MCOs providing coverage for home care services:
- Amerihealth Caritas North Carolina
- Carolina Complete Health
- Healthy Blue North Carolina
- UnitedHealthcare Community Plan of North Carolina
- WellCare of North Carolina
For detailed assistance and to identify the right MCO for your agency, reach out to us.
