ObjectiveTo evaluate the effectiveness of increased primary care access created by North Carolina's Medicaid managed care plan, Carolina Access (CA), in
Related Content: Value-based Care in North Carolina Accountable Entity (AE) See: Accountable Care Organizations. Advisory Board or Group Comprised of enrollees, payers, providers, and advocates, advisory boards or groups offer guidance on movements, policy, and initiatives within the health care...
even with the infusion of federal money. In those states, Medicaid seems to be more limited (to only the poorest of the poor) and also to have fewer providers. Georgia comes up a lot in this context, but North and South Carolina, Tennessee, Mississippi,...
Background Postpartum visits are a vital part of maternity care, presenting the opportunity to perform well woman care, address contraceptive needs, and screen for postpartum depression and chronic disease. North Carolina’s Pregnancy Medical Home (PMH) program for Medicaid patients offers maternity ...
use of Medicaid Fraud Control Unit (MFCU) Investigative Subpoenas to obtain records, Medicaid Fraud Control Unit (MFCU) Search Warrants used to seize patient records, billing records and computers, Medicaid audit letters from the Agency for Health Care Administration (AHCA), and related activities....
A 2017 federal audit report found that Texas was improperly billing for services not allowable under the SHARS program. The report concluded the state would need to return almost $19 million, a fraction of the $607 million currently being left behind. It also required that the Texas health com...
41,43,48-50 To improve specialist participation, states may consider increasing reimbursement rates, simplifying billing procedures, expediting the reimbursement process, and improving administrative protocols to address claims denials and resubmissions.41,49,50 Moreover, practitioner shortages, especially ...
Preventative carerates among youth in Medicaid managed care increased significantly in 17 states, decreased significantly in six states, and stayed the same in 28 states. Tennessee had the largest increase in preventive care associated with Medicaid managed care and North Carolina exp...
Billing codes indicating colorectal cancer screening procedures or exclusion criteria. This table presents all of the CPT, HCPCS, and ICD-9 Procedure codes that we applied to our claims data in order to assess the primary outcome of CRC testing and modality used. We present our codes for screen...
41,43,48-50 To improve specialist participation, states may consider increasing reimbursement rates, simplifying billing procedures, expediting the reimbursement process, and improving administrative protocols to address claims denials and resubmissions.41,49,50 Moreover, practitioner shortages, especially ...