Topics Related to All Providers

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

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.

Claims Denied – Taxonomy Codes Missing, Incorrect, or Inactive

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

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.

Expedited Hardship Advances for Managed Care Providers

May be available for those at risk of not meeting financial obligations

Billing Guidance for Children’s Developmental Services Agency Providers

Claims may be submitted to NCTracks for all IFSP services for dates of service starting on July 1, 2021.

Procedures for Prior Authorization of Palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2021-2022

Coverage season will begin Aug. 15, 2021

Potential Clinically Integrated Networks or Other Partners Statement of Interest

All responses have been received and are available.

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

NC Medicaid advanced 54 providers to the site review stage.