April 2025 Provider Newsletter

Fecha: 16/04/25

Clinical Policy Updates

Ambetter of North Carolina Inc. continuously updates select clinical policies each month. 

The following policy updates are effective 07/01/2025.

17 policies were reviewed and approved.

• 7 policies had no changes
• 4 policies were revised making them less restrictive
• 6 policies were revised making the new version both more and less restrictive:
  • CP.MP.62 Hyperhidrosis Treatments
  • CP.MP.107 DME
  • CP.MP.142 Urinary Incontinence Devices and Treatments
  • CP.MP.180 Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
  • CP.BH.104 Applied Behavior Analysis
  • CP.BH.105 Applied Behavioral Analysis Documentation Requirements

This page reflects upcoming clinical policy changes. Revision notes are made available in the policy document.

Pay-for-Performance (P4P) Program

The Pay-for-Performance (P4P) program is designed to incentivize providers to deliver high-quality value-based care. Through this program, providers can earn financial incentives by meeting key performance measures such as preventive care, chronic disease management, and patient engagement.

By aligning provider efforts with quality improvement goals, the P4P program supports better health outcomes for Ambetter’s members while enhancing provider reimbursement opportunities. The slides outline provider participation requirements, the specific performance measures evaluated, target thresholds for financial incentives and the payment schedule. For more information, please contact yourProvider Engagement Administrator.

View our new Provider Education on the 2025 P4P program here!

Don’t Miss Out on Secure and Faster Payments with Payspan!  

Ambetter of North Carolina Inc. offers Payspan, a free and powerful solution designed to help providers like you transition to electronic payments and automatic reconciliation. With Payspan, you’ll enjoy the following benefits: 

• Speed: Receive payments directly to your account faster than ever before.  
• Security: A safer, more secure method to ensure funds arrive without hassle.  
• Reliability: Payspan ensures payments are delivered even in extreme circumstances. For example, after Hurricane Helene, CCH successfully delivered payments to providers’ accounts despite power outages and postal service disruptions.  

Switching to Payspan Electronic Funds Transfer (EFT) is the fastest and most efficient way to ensure your payments are hassle-free.  
 
Activating your account is simple. Below are step-by-step instructions for obtaining your registration code and completing the activation process. Should you need assistance, Provider Engagement is here to help. Reach out to us via email: ProviderEngagement@cch-network.com
 
CCHN Payspan User Training Guide.

 The North Carolina Guide to Diabetes Prevention and Management

Diabetes impacts a large percentage of many communities, touching the lives of patients, family members, friends, and colleagues. Recognizing the prevalence of this disease, the North Carolina Diabetes Advisory Council (NC DAC) is urging support to ensure that vital resources reach those who need them most. The North Carolina Guide to Diabetes Prevention and Management, 3rd Edition is designed to be a valuable tool for both individuals and healthcare providers in the fight against diabetes.

This guide offers essential information on diabetes, including its effects on the population in North Carolina, and practical strategies for prevention and management. The third edition of this guide includes up-to-date content on diabetes awareness, prevention techniques and management strategies. This makes it an indispensable resource for anyone looking to take proactive steps in managing or preventing diabetes. It is available for easy access through download or print, ensuring that it can be readily shared with those who would benefit. To access the guide, just simply register. This process makes it easy to get this critical information into the hands of those who need it most. By supporting this initiative, you can help spread the knowledge that can make a significant difference in the lives of many people.

Ambetter Member Advisory Group Engages Members about their Marketplace Insurance

The Ambetter Member Advisory Group offers a great opportunity for members to discuss their journey in choosing Ambetter and to participate in a conversation about the effectiveness of the health plan, policies, and services. This collaborative effort from Ambetter leaders and staff engages members to provide their feedback about what is working with the Health Plan and how it can be improved.

We encourage providers to refer patients/members to join the Member Advisory Group. Members can join virtually, on Wednesday, June 4, 2025, from 5:00p-6:30p! The first 25 members to RSVP/Register and attend the meeting will receive a $25 Walmart gift card. For more information, members can contact Member Services at 844-972-0785.        

North Carolina Medical Board Member Seats Openings

The North Carolina Medical Board is currently accepting applications for open Board Member seats. The open seats are:

• Three (3) seats for a physician

The term for these open seats will begin in November 2025. NCMB Will be accepting applications through June 23, 2025. Information about applying to serve on the Board can be found on the NCMB Review Panel website here.

New Provider Orientation

During the New Provider Orientation, we will discuss the following:

• Ambetter benefits
• Verification of Eligibility and benefits
• Accessing the public website and secure web portal
• Prior Authorizations
• Claims
• Provider Billing Manual and Provider Tool kit

Ambetter of North Carolina Inc. holds New Provider Orientations monthly on the third Tuesday of the month at 12PM ET.

• Register in advance for this meeting
• After registering, you will receive a confirmation email containing information about joining the meeting.

Ambetter of North Carolina Inc. also has an on-demand option for your New Provider Orientation.

• View the recording

Once you complete an orientation, please submit your attestation.

Provider Manual

Visit Provider Resources for the most up-to-date version of the Ambetter of North Carolina Inc. Provider and Billing Manual: 
https://www.ambetterofnorthcarolina.com/provider-resources/manuals-and-forms.html