Topics Related to Medicaid Managed Care

NC Medicaid Managed Care Provider Update – May 22, 2023

Update includes provider verification, billing requirement modifications; Tailored Plan implementation, upcoming key milestones, playbook updates and more.

Electronic Visit Verification Required for Home Health Care Services

Effective immediately, all providers must use the Electronic Visit Verification vendor of their choice for every home health visit.

Electronic Visit Verification for Home Health Services: Revised Implementation Dates - March 31, 2023

Implementation guidelines reflect the Tailored Plan launch date of Oct. 1, 2023.

Identifying Other Found Insurance for NC Medicaid Managed Care Members

Process change for Providers identifying Other Found Insurance for NC Medicaid Managed Care Members

Durable Medical Equipment and Orthotic and Prosthetic Manually Priced Procedure Codes - Prior Authorization Update

A new prior authorization is required for beneficiaries returning to NC Medicaid Direct

Local Management Entity/Managed Care Organization Enrollment Changes for April 1, 2023

Behavioral health prior authorizations effective April 1, 2023

NC Medicaid Managed Care Provider Update – March 22, 2023

Implementation of Tailored Plans, playbook update, Provider reverification, NC Health Choice move to Medicaid, NCTracks Provider records and more.

NC Health Choice Move to Medicaid: Timeline for Claims Adjudication and Process for Prior Approvals

As of April 1, 2023, all NC Health Choice beneficiaries with active eligibility will be moved to Medicaid.

NC Medicaid Managed Care Capitation Rates – Care Management Assumptions

Updated information about the assumptions underlying the care management component of capitation payments to Standard Plans

North Carolina Standard Plan, Tailored Plan and LME/MCO Tobacco-Free Policy Requirement

Tobacco-related policy requirements go into effect on April 1, 2024.