Identifying Other Found Insurance for NC Medicaid Managed Care Members

Process change for Providers identifying Other Found Insurance for NC Medicaid Managed Care Members

NC Medicaid is transitioning away from NCTracks for the identification of an NC Medicaid Managed Care member’s Other Found Insurance. This change will improve claims adjudication results and reduce claims preparation time.

Providers should first verify the member is actively enrolled in the designated health plan, and then query for other insurance coverage using either – 1) real-time Electronic Data Interchange transactions (270/271), or 2) the health plans’ provider portals. Below are links to the health plan portals:

Providers should continue to use NCTracks to verify other found insurance for NC Medicaid Direct beneficiaries.

Reporting Other Insurance Updates for NC Medicaid Direct Recipients 

Providers should complete the DHB Health Insurance Information Referral Form to report any updates or additions for NC Medicaid Direct beneficiaries’ other found insurance. Questions about the form should be directed to the Medicaid Third-Party Liability vendor Gainwell Technologies at 866-263-2227, option 3. Gainwell does not update Medicare coverage for beneficiaries.

Medicare Coverage

Medicare coverage inquiries should be directed to the DHB Buy-in team:

Jacqueline Gunter
Priscilla Pitt
Sara Harris

You may also reach a DHB Buy-in team member by calling 919-527-7690.

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