Hospital Procedure Continuity at NC Medicaid Managed Care Launch
NC Medicaid wants to ensure beneficiaries receive the care they need as scheduled prior to July 1.

NC Medicaid wants to ensure that during the transition to NC Medicaid Managed Care that Medicaid beneficiaries receive the care they need as scheduled prior to July 1.

Note: This bulletin has been replaced by Prepaid Health Plan Flexibility for Prior Authorizations During First 60 days after Managed Care Launch
 published on July 7, 2021.

NC Medicaid wants to ensure that during the transition to NC Medicaid Managed Care that Medicaid beneficiaries receive the care they need as scheduled prior to July 1. This includes confirming that procedures for care scheduled prior to July 1 continue without interruption. 

The Department and the health plans want to give providers the information they need to provide care to beneficiaries and receive reimbursement for the care that is provided. To support this effort, the Department is compiling the following information for hospitals/facilities and providers to make sure that they have the information to maintain their scheduled procedures. 

It is critical for hospitals and health systems to share this information broadly and to include their care teams at all levels of the organization, including outpatient facilities and clinics, schedulers, phone centers and individual departments.

The health plans provide information on how they are handling prior authorizations on their website and Quick Reference Guides. Please see the below links and bullets on how you can find out more information. Additionally, hospitals/facilities can access the NC Medicaid Managed Care Provider Playbook for the latest information, tools and other resources to help with the transition to managed care.

To further guarantee that providers and hospitals have confidence in their ability to receive payment for services rendered, the Department will monitor authorization and claims data from the health plans to verify that they are following the above described prior authorization waivers. 

We remain committed to working with our provider and health plan partners to verify services are paid for without undue burden to our beneficiaries during this transition. If providers experience issues during this transition period, they can reach out to the Medicaid Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 919-527-6666.

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