The State solution for reporting electronic visit verification and aggregation is Sandata.
Topics Related to 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.
Providers must submit ALL eyeglasses prior approval requests for NC Medicaid Direct beneficiaries and health plan members to NCTracks.
Guidance to pharmacies on prior authorizations that transfer from a health plan to 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.
Durable Medical Equipment (DME) is covered under NC Medicaid Managed Care for beneficiaries enrolled in a managed care plan and under NC Medicaid Direct for those beneficiaries who remain in NC Medicaid Direct.
Prepaid Health Plans (PHPs) began providing non-emergency medical transportation (NEMT) and non-emergency ambulance transportation (NEAT) services for PHP members on July 1, 2021.
The following services should continue to be billed through NCTracks.
End-Dating the Use of Taxonomy Code 313M00000X (Nursing Home-Intermediate Level of Care) From Provider Permissions Matrix, Continuation of Temporary Suspension of Level I and Level II Assessments for New Nursing Home Admissions, NCMUST Webpage Update, PASRR Submission and Required Supporting Documentation
To assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program, NCDHHS generated a new Advanced Medical Home (AMH) NC Medicaid Direct/NC Medicaid Managed Care Primary Care Provider (PCP) Enrollee Report for distribution to CCNC/CA participating providers.