Effective April 1, 2023, beneficiaries ages 0-3 and fully qualified legal immigrants who are in NC Medicaid Direct will be enrolled in the Local Management Entities/Managed Care Organizations (LME/MCOs). LME/MCOs manage the care of NC Medicaid Direct beneficiaries who receive behavioral health services (services for mental health, developmental disabilities or substance use disorders).
As a result of this change, most prior authorizations for behavioral health services for these beneficiaries (except for Cumberland Hospital and Children’s Development Services Agency (CDSA) services) will no longer be submitted to Carelon Behavioral Health (formerly Beacon Health Options).
Please note that the following types of authorizations will continue to be submitted to Carelon:
- Behavioral health requests for Cumberland Hospital, and
- Behavioral health requests for CDSA services which are:
- Documented in an individualized family service plan (IFSP), and
- Provided and billed by a CDSA or a provider contracted with a CDSA to provide those services.
Aside from the above listed services, starting on April 1, 2023, all other behavioral health prior authorizations for these populations should be submitted to the member’s assigned LME/MCO.
As a reminder, children under the NC Health Choice program will be moving to Medicaid effective April 1, 2023. Behavioral health requests for these children who remain in Medicaid Direct will no longer be sent to Carelon but will be sent to the LME/MCOs.
Claims for these populations sent to NCTracks, starting for services rendered on April 1, 2023, and after, should be submitted to the member’s assigned LME/MCO. Claims for CDSA services (as described above) will continue to be sent to NCTracks.
Contact
NC Medicaid Contact Center: 888-245-0179