Topics Related to Medicaid Managed Care

National Correct Coding Initiative Reminder

All state Medicaid programs are required to incorporate methodologies.

Tailored Care Management 101 Webinar Series

The webinar series runs from October through mid-December.

Keep NCTracks Records Current to Avoid Claims Processing Issues

The NCTracks provider record serves as the source of truth for managed care entities.

Prepaid Health Plan Interest and Penalties for Provider Claims

Prepaid health plans are required to pay interest and penalties to providers if they fail to accurately pay or inappropriately deny a claim.

NC Medicaid Managed Care Provider Update – Sept. 15, 2021

Topics include key dates, playbook updates, prior authorization, FAQs, contracting, ombudsman, webinars and more.

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.

North Carolina Standard & Tailored Plan Tobacco-Free Policy Requirement

Tobacco-related policy requirements go into effect on July 1, 2022.

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

In-Network Provisions Extended Through September

To support providers during the recent COVID-19 surge, the policy for in-network provider provisions has been extended

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.