The Oct. 1, 2023, start date allows LME/MCOs to contract with more providers to support member choice and to validate that data systems are working appropriately. For more information, please see Medicaid bulletin article NCDHHS Delays Implementation of the NC Medicaid Managed Care Behavioral Health and I/DD Tailored Plans.
Provider Playbook Updates
The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. Providers are encouraged to review each of the following sections for updates and resources to help with their specific need:
- Trending Topics
- Fact Sheets
- Frequently Asked Questions
- Training Courses
- Beneficiary Materials
- Fee Schedule Archives
Quick Links are also provided making this webpage a single source to access all things Medicaid managed care.
Provider Reverification
NC Medicaid has received confirmation in a Statement of Administrative Policy from the Executive Office of the President of the United States that the federal PHE will end on May 11, 2023. Although the voluntary reverification program is currently underway, all providers should be aware that notices to any provider with an approaching reverification due date will begin as the federal PHE ends.
Some providers received notification of a voluntary reverification program underway through March 2023. This is a time-limited opportunity that allows providers to get ahead of the reverification rush and is applicable to only those providers who were due for reverification during the federal PHE. No adverse action will occur if the provider does not submit the voluntary reverification application. For more information, see the Voluntary Reverification Bulletin article.
Providers should note reverification notifications received beginning in May, at the end of the federal PHE, represent the required reverification process . Providers must respond to avoid adverse action to their NC Medicaid participation status. More information is forthcoming about the end of the federal PHE.
Keep NCTracks Provider Records Current
NC Medicaid recently announced a Provider Data Management/Credentialing Verification Organization Solution Coming in 2024. In addition, the Department continues to offer Provider Directory Listing and Affiliation Reports for Standard Plans and Tailored Plans in the Provider Playbook as a resource for verifying basic information in the NCTracks provider record, as well as the contract status with health plans.
Since the latest information the current provider enrollment and data management system components of NCTracks will be replaced, and data from current records converted into the solution, providers have added incentive to ensure all data in each active NCTracks provider record is accurate.
Related to the Provider Directory Listing and Affiliation Reports, providers may filter to review information about multiple records simultaneously. A “Field Description” tab is available on the report that allows you to connect the section of the “Manage Change Request” (MCR) to the field in the report displaying the information. To review the NCTracks provider record in its entirety, providers may use the full MCR process in the NCTracks Secure Provider Portal. If outdated or erroneous information is found using either resource, the Office Administrator must submit the MCR to report the change.
The ongoing accuracy of provider enrollment information is not only contractually required of providers, but also increasingly vital to the successful sharing of data among health plans and the incorporation into new solutions.
For additional information, see the related bulletin article here.
NC Health Choice Move to Medicaid
NC Health Choice is moving to Medicaid on April 1, 2023. General information on the move can be found here: https://medicaid.ncdhhs.gov/nc-health-choice-move-medicaid. Links to Fact Sheets, bulletins, and frequently asked questions will be posted in the “More” section of this page.
Provider Ombudsman
Each health plan has a grievance and appeal process for providers, separate from the process for beneficiaries, which can be found in the 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.
Responses to inquiries are autogenerated from ServiceNow and sent directly to the inquirers email address. The subject line will read “NC Medicaid Inquiry COM00XXXXX Has Been Closed” and be sent from this email address: IT Service Desk Medicaid.HelpCenter@dhhs.nc.gov.
Help Center Available for Providers to Find Information
The NC Medicaid Help Center is an online source of information about NC Medicaid Managed Care, COVID-19,Medicaid and behavioral health services, and is used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this 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
Visit the AHEC Medicaid Managed Care webpage for additional information and registration for upcoming webinars, as well as recordings, slides and transcripts from previous 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
Provider Ombudsman: 866-304-7062