Blog Entry List

North Carolina Standard & Tailored Plan Tobacco-Free Policy Requirement

Tobacco-related policy requirements go into effect on July 1, 2022.

Interim Process for Submitting Prior Authorization Requests for Beneficiaries Disenrolled to NC Medicaid Direct

Providers are encouraged to confirm which PA types are included in this long-term design.

Eyeglasses Prior Approval and Dispensing Fee Claims Submission When a Beneficiary Transitions to NC Medicaid Direct – Aug. 30, 2021

This replaces the bulletin, published on Aug. 4, 2021

Claims Denied – Taxonomy Codes Missing, Incorrect, or Inactive

Taxonomy codes must be included when submitting claims to prepaid health plans

Rebate Eligible Prescription Drug Coverage by Prepaid Health Plans

PHPs are required to provide drug coverage to Medicaid beneficiaries consistent with the drug coverage determined by NC Medicaid under fee for service.

In-Network Provisions Extended Through September

To support providers during the recent COVID-19 surge, the policy for in-network provider provisions has been extended

Tailored Care Management: Conflict-Free Care Management Guidance

Ensure compliance with the HCBS final rule and prepare Tailored Plans and Providers for the launch of Tailored Care Management.

Extension of Out-of-Network Provisions

The policy is extended through Nov. 30, 2021.

Tailored Care Management Update: AMH+/CMA Certification Round One Desk Reviews Completed

NC Medicaid advanced 54 providers to the site review stage.

Potential Clinically Integrated Networks or Other Partners Statement of Interest

All responses have been received and are available.

Guidance to Pharmacies Supporting Beneficiaries Transitioning to NC Medicaid Direct

Guidance to pharmacies on prior authorizations that transfer from a health plan to NC Medicaid Direct.

Prior Authorizations for Medically Necessary Contact Lenses When a Beneficiary Transitions NC Medicaid Direct

Providers must submit a contact lens prior approval request to NCTracks for a beneficiary who has transferred back to NC Medicaid Direct.

Eyeglasses Prior Approval and Dispensing Fee Claims Submission When a Beneficiary Transitions to NC Medicaid Direct

Providers must submit ALL eyeglasses prior approval requests for NC Medicaid Direct beneficiaries and health plan members to NCTracks.

Prior Authorizations Covered When a Beneficiary Transitions to NC Medicaid Direct

When an NC Medicaid Managed Care member becomes part of a population exempted or excluded, they are disenrolled and transition to NC Medicaid Direct.

What Providers Need to Know After the July 1, 2021 Full Launch of Electronic Visit Verification

The State solution for reporting electronic visit verification and aggregation is Sandata.