Topics Related to Medicaid Managed Care

Electronic Visit Verification System for Home Health Care Services Soft Launch Extended Through July 31

All Home Health Care providers are expected to be fully compliant with requirements on Aug. 1

NC Medicaid Managed Care Provider Update – June 16, 2023

Includes provider recredentialing/reverification, billing requirement modifications, Tailored Plan implementation, upcoming key milestones, playbook updates and more.

Provider Payment and Claims Submission Fact Sheets

Fact sheets covering Provider payment, reimbursement, claims submissions and prior authorization have been recently published on the NC Medicaid website.

NC Medicaid Managed Care Provider Update – May 22, 2023

Update includes provider verification, billing requirement modifications; Tailored Plan implementation, upcoming key milestones, playbook updates and more.

Electronic Visit Verification Required for Home Health Care Services

Effective immediately, all providers must use the Electronic Visit Verification vendor of their choice for every home health visit.

Electronic Visit Verification for Home Health Services: Revised Implementation Dates - March 31, 2023

Implementation guidelines reflect the Tailored Plan launch date of Oct. 1, 2023.

Identifying Other Found Insurance for NC Medicaid Managed Care Members

Process change for Providers identifying Other Found Insurance for NC Medicaid Managed Care Members

Durable Medical Equipment and Orthotic and Prosthetic Manually Priced Procedure Codes - Prior Authorization Update

A new prior authorization is required for beneficiaries returning to NC Medicaid Direct

Local Management Entity/Managed Care Organization Enrollment Changes for April 1, 2023

Behavioral health prior authorizations effective April 1, 2023

NC Medicaid Managed Care Provider Update – March 22, 2023

Implementation of Tailored Plans, playbook update, Provider reverification, NC Health Choice move to Medicaid, NCTracks Provider records and more.