New Primary Care Provider Change Request Form for Members in Managed Care Prepaid Health Plans

This form is for members who wish to change their primary care assignment throughout the year.

In collaboration with primary care providers (PCPs), the NC Medicaid Managed Care Prepaid Health Plans (PHPs) have created a new standardized PCP Change Request Form for members who wish to change their primary care assignment throughout the year. A link to each health plan’s form can be found here:

As a reminder, beneficiaries can change their PCP/Advanced Medical Home (AMH) without cause twice each year.  

Below are the different ways beneficiaries can change their PCP/AMH: 

  • Beneficiaries can select a PCP/AMH at application, recertification or through choice counseling with the Enrollment Broker when they change a health plan. 
  • Once assigned a health plan, beneficiaries should contact their health plan to change their PCP/AMH using this form or by calling each plan’s Member Services directly. Contact information can be found in the Member Handbook on the Health Plan Contacts and Resources Page.  
  • Beneficiaries can change their PCP or health plan at any time over the course of the year if they have care or quality concerns. This is known as a change ‘with cause.’ This PCP Change Request Form should not be utilized to process ‘with cause’ member requested changes. Those ‘with cause’ requests should be processed by calling each plan’s Member Services directly. 

Contact

Medicaid Contact Center: 888-245-0179

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