Topics Related to Medicaid Managed Care

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.

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.