Topics Related to Medicaid Managed Care

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.

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.

NC Medicaid Managed Care Provider Update – Aug. 4, 2021

Key milestones, playbook updates, prior authorizations, FAQs, contracting, ombudsman, webinars and more.

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.