Upcoming Key Milestone Dates for NC Medicaid Managed Care
- March 15, 2022 - Healthy Opportunities Pilot food services launch
- May 1, 2022 - Healthy Opportunities Pilot housing and transportation services launch
- June 15, 2022 - Tailored Plan Member Services lines go-live
- June 15, 2022 - Enrollment Broker provider directory updated to include Tailored Plan providers
- June 15, 2022 - Healthy Opportunities Pilot toxic stress and cross-domain services launch
- Aug. 1, 2022 - Beneficiaries will be assessed to confirm qualification for Tailored Plan. Beneficiaries that no longer qualify will receive a notice from the Enrollment Broker about their choices
- Aug. 15, 2022 - Tailored Plan Auto-Enrollment begins. Enrollment Broker begins mailing Enrollment Packets to beneficiaries
- Aug. 15, 2022 - Beneficiary Choice Period begins; Beneficiaries can choose a primary care provider (PCP) and Tailored Care Management provider by contacting their Tailored Plan
- Oct. 14, 2022 - Last day for beneficiaries to choose a PCP and Tailored Care Management provider before auto-assignment
- Oct. 15, 2022 - PCP and Tailored Care Management provider Auto-Assignment (by Tailored Plan) for beneficiaries who have not chosen a PCP or Tailored Care Management provider
- Nov. 1, 2022 - Tailored Plan Pharmacy, Nurse, and Behavioral Health Crisis lines go live
- Dec. 1, 2022 - Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans launch
Provider Playbook Updates
The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. The latest resources added to the fact sheet page are:
- What Providers Need to Know: Part 3 - Before Tailored Plan Launch, which provides an overview of Tailored Plan Launch with key dates, reminders and contact information.
- Children and Youth Transitioning to Foster Care for Providers, which provides information and guidance on the current foster care process for providers and includes contact information. In the County Playbook, there is also a foster care fact sheet providers can refer members to for information on the transition. English | Spanish
COVID-19 Vaccine Incentive Program
A fact sheet covering the Vaccine Incentive Program has been posted to the NC Medicaid COVID-19 Guidance and Resources Page. The fact sheet provides a summary of each Standard Plan COVID-19 Member Incentive Program and links to more detailed information on the Standard Plan member incentives.
Provider Prior Authorizations
If a provider needs to verify the status of a PA request, please contact the health plan provider relations team directly at:
- AmeriHealth Caritas: Provider Services: 888-738-0004
- Carolina Complete: Provider Services: 833-552-3876
- Healthy Blue: Provider Services: 844-594-5072
- United Healthcare: Provider Services: 800-638-3302
- WellCare: Provider Services: 866-799-5318
For more information about PAs, see the Managed Care Claims and Prior Authorization Submission fact sheets under Programs and Services.
Provider Ombudsman
Each health plan has a grievance and appeal process for providers, separate from the process for beneficiaries, which can be found in each health plan’s Provider Manual, linked on the Health Plan Contacts and Resources Page.
The Provider Ombudsman service is separate from the Health Plans’ Provider Grievances and Appeals process and should be used as an escalation after contacting Health Plans and searching the NC Medicaid Help Center.
Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or by calling the NC Medicaid Managed Care Provider Ombudsman at 866-304-7062.
Ensure Your Information Displays Correctly in North Carolina’s Provider Directory – Medicaid and NC Health Choice Provider and Health Plan Look-Up Tool
Reports are available on the Managed Care Provider Playbook Resources page to assist providers in verifying their records. The Provider Directory Listing Report, as well as the Provider Affiliation Report, is available to all actively enrolled Medicaid and NC Health Choice providers. In combination, these reports allow all providers to confirm the information visible to NC Medicaid beneficiaries on the “Medicaid and NC Health Choice Provider and Health Plan Look-up Tool.”
For assistance with completing an NCTracks Manage Change Request, providers should reference the NCTracks Provider User Guides and Training tools located at: https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html.
PHP Quick Reference Guides
NC Medicaid’s Managed Care Prepaid Health Plans (PHPs) created quick reference guides to include the most current and comprehensive information for providers.
The PHP quick reference guides are available on the Provider Playbook Fact Sheet webpage under the Health Plan Resources section. Links to the health plan training webpages have also been added to the Provider Playbook Training Courses webpage.
Help Center Available for Providers to Find Information
The NC Medicaid Help Center is an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this new tool:
- Go to NC Medicaid Help Center
- Type a topic or key words into the search bar
- Select a topic from the available list of categories
Detailed information about the NC Medicaid Help Center is available in a Medicaid Bulletin updated on June 17, 2021.
NC Medicaid Managed Care Webinars
The latest schedule, registration and information on previous webinars, including the recording, slides, and transcript are available on the AHEC Medicaid Managed Care website.
Contact
NCTracks Call Center: 800-688-6696