Topics Related to Medicaid Managed Care

Children’s Developmental Services Agency Providers Carved Out of Managed Care

The following services should continue to be billed through NCTracks.

Nursing Facilities Supporting NC Medicaid Only Residents Enrolled in NC Medicaid Managed Care: Prior Authorizations

This bulletin provides guidance to nursing facilities serving NC Medicaid-only residents transitioning to managed care on July 1.

NC Medicaid Managed Care Provider Update – June 16, 2021

Key milestone dates, where to turn for help, Provider Playbook, PHP quick reference guides, webinars, Provider Directory, Help Center and Provider Ombudsman.

NC Medicaid Specialized Foster Care Plan Update Webinar

DHHS will hold a webinar on June 4, 2021, to provide an update on the development of the Specialized Foster Care Plan. 

NC Medicaid Managed Care Provider Update – May 28, 2021

Topics include: key dates, contracting reminders, provider ombudsman, playbook updates, outreach to patient panels, webinars, provider directory, PHP quick reference guides, Help Center and Tailored Care Management certification.

NC Medicaid Managed Care Health Plan Assignments Completed for Beneficiaries

Medicaid beneficiaries currently eligible to transition to managed care have selected or been assigned a health plan. 

Prior Approval for Nursing Home Residents Moving from NC Medicaid Managed Care to Medicaid Direct

End-Dating the Use of Taxonomy Code 313M00000X (Nursing Home-Intermediate Level of Care) From Provider Permissions Matrix, Continuation of Temporary Suspension of Level I and Level II Assessments for New Nursing Home Admissions, NCMUST Webpage Update, PASRR Submission and Required Supporting Documentation

Data on Medicaid and NC Health Choice Beneficiary Eligibility for Behavioral Health I/DD Tailored Plans and Tailored Care Management

NCDHHS is releasing data on the number of beneficiaries, as of April 2021, who currently meet the eligibility criteria to enroll in Tailored Plans and receive Tailored Care Management scheduled to launch in July 2022.

Tailored Care Management Updates - May 14, 2021

NC Medicaid has published updated guidance on Tailored Care Management, including updates on Advanced Medical Home + (AMH+)/Care Management Agency (CMA) Certification, capacity building and rates.

NC Medicaid Managed Care Open Enrollment Ends Friday, May 14 

NCDHHS is in its final week of open enrollment for NC Medicaid Managed Care. Through Friday, May 14, beneficiaries can choose a primary care provider (PCP) and a health plan for their families’ care in preparation for the launch of NC Medicaid Managed Care on July 1.