Topics Related to Medicaid Managed Care
The following guidance applies to AMH Tier 3 practices not participating in the NC Integrated Care for Kids (InCK) pilot project.
Provides an overview of the Department’s plans for promoting high-quality care through managed care and provides specific details to the measurement for the goals and objectives of the Department’s Quality Strategy.
Since the launch of NC Medicaid Managed Care on July 1, 2021, providers have submitted claims to the prepaid health plans (PHPs) for services provided to beneficiaries who are enrolled with that PHP. NCDHHS established provider payment requirements for PHPs to encourage continued provider participation in the Medicaid program, to ensure beneficiary access and support safety net providers and to ensure continuation of current reimbursement levels.
Fact sheets that address questions related to the Standard Plan disenrollment process for children in foster care are now available.
Key dates, Playbook updates, Medicaid Direct, fabrication of eyeglasses, managed care eligibility for newborns, prior authorization, FAQs, Provider Ombudsman, Provider directory, PHP quick reference guides and help center.
Summary network adequacy results for Standard Plans are available.
AMH Provider Manual 2.2 reflects North Carolina’s Integrated Care for Kids (InCK) pilot program expectations and changes that impact Advanced Medical Home Tier 3 contracts with Standard Plans.
The seven-part series covers current policies and procedures under the new NC Medicaid Managed Care guidelines.
Standard Plans temporarily extended minimum appeal timeframes to support the transition to NC Medicaid Managed Care.
Upcoming Key Milestone Dates, Playbook Updates, Request to Move to NC Medicaid Direct Process, Prior Authorizations, Frequently Asked Questions, Contracting Reminders, Ombudsman and Webinars