Topics Related to Medicaid Managed Care
Claims without the required EVV data will be denied.
The North Carolina Department of Health and Human Services (the Department) is releasing updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Prepaid Health Plan (PHPs) Standard Plans. The PHP Standard Plan capitation rates developed by the Department reflect its belief that investment in robust community-based care management will drive improvements in care outcomes and achieve greater value from the state’s Medicaid dollar.
This bulletin replaces NC Medicaid Temporary Flexibilities Due to Hurricane Idalia published on Aug. 30, 2023, to correct the end date.
Provider guidance for reimbursement, enrollment and providing care for Medicaid beneficiaries
Includes provider recredentialing/reverification, Medicaid expansion, Tailored Plan implementation and more.
This bulletin provides information about referrals for specialty care for NC Medicaid beneficiaries.
Includes flexibilities related to Tailored Plans and Healthy Opportunities Pilots
With state budget negotiations ongoing, NCDHHS has worked with CMS to negotiate a compromise to begin submitting documents needed for federal approval to launch Medicaid expansion on October 1, 2023.
Includes provider recredentialing/reverification, billing requirement modifications, Tailored Plan implementation, upcoming key milestones, playbook updates and more.
All Home Health Care providers are expected to be fully compliant with requirements on Oct. 1, 2023.