Topics Related to Medicaid Direct

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

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.

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.

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.

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.

Durable Medical Equipment Coverage

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.

Non-Emergency Transportation for NC Medicaid Managed Care

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.

Children’s Developmental Services Agency Providers Carved Out of Managed Care

The following services should continue to be billed through NCTracks.