Topics Related to Medicaid Managed Care

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.

NC Medicaid Managed Care Provider Update – Aug. 4, 2021

Key milestones, playbook updates, prior authorizations, FAQs, contracting, ombudsman, webinars and more.

What Providers Need to Know After the July 1, 2021 Full Launch of Electronic Visit Verification

The State solution for reporting electronic visit verification and aggregation is Sandata.

Prior Authorizations Covered When a Beneficiary Transitions to NC Medicaid Direct

When an NC Medicaid Managed Care member becomes part of a population exempted or excluded, they are disenrolled and transition to NC Medicaid Direct.

Eyeglasses Prior Approval and Dispensing Fee Claims Submission When a Beneficiary Transitions to NC Medicaid Direct

Providers must submit ALL eyeglasses prior approval requests for NC Medicaid Direct beneficiaries and health plan members to NCTracks.

Guidance to Pharmacies Supporting Beneficiaries Transitioning to NC Medicaid Direct

Guidance to pharmacies on prior authorizations that transfer from a health plan to NC Medicaid Direct.

Prior Authorizations for Medically Necessary Contact Lenses When a Beneficiary Transitions NC Medicaid Direct

Providers must submit a contact lens prior approval request to NCTracks for a beneficiary who has transferred back to NC Medicaid Direct.

NCDHHS Announces Medicaid Managed Care Regional Behavioral Health I/DD Tailored Plans

DHHS announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans).