Note: This bulletin is replaced by NC Health Choice Move to Medicaid: Timeline for Claims Adjudication and Process for Prior Approvals.
Topics Related to Medicaid Direct
NC Medicaid is implementing new Managed Care Nursing Facility rates to support nursing facility providers and NC Medicaid members.
Key milestones, playbook updates, verifying eligibility, provider reverification, provider records, behavioral health services transition and more
The adjudication of some prior approvals will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid
Evaluates the impact of the North Carolina Medicaid Transformation on primary care and obstetrics/gynecology (Ob/Gyn) practices
A delay in identifying individuals in NCTracks as dually eligible for Medicare and Medicaid has been discovered.
From Dec. 1, 2022, to June 30, 2023, they will receive an enhanced medical home payment of $20 per member per month.
Key milestones, playbook updates, verifying eligibility, reverification and more
NC Medicaid Direct PA effective begin and end dates will be modified to align with the individual’s eligibility segment.
Key milestones, playbook updates, verifying beneficiary eligibility, provider reverification, review provider record in NCTracks and more.