Since the launch of NC Medicaid Managed Care on July 1, 2021, providers have submitted claims to the prepaid health plans (PHPs) for services provided to beneficiaries who are enrolled with that PHP. NCDHHS established provider payment requirements for PHPs to encourage continued provider participation in the Medicaid program, to ensure beneficiary access and support safety net providers and to ensure continuation of current reimbursement levels.
The Department worked closely with PHPs to share information on the steps needed to file a claim for each PHP. In alignment with NCDHHS’ proactive communication and transparency values, a new NC Medicaid Managed Care dashboard has been added to the Reports page of the NC Medicaid website with top reasons for claim denials for each PHP. The dashboard will be updated monthly and includes notes to give context to the data.
Providers are encouraged to work directly with the PHPs to resolve any issues with their claim submissions. If a provider continues to have unresolved payment issues, they should contact the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 866-304-7062.