NC Medicaid is committed to ensuring our providers and members are supported during Behavioral Health Intellectual/Developmental Disabilities (I/DD) Tailored Plan implementation. Key priorities are ensuring NC Medicaid Members receive the care they need as scheduled, with no interruption, and Providers can continue to be paid for providing services.
The Department implemented several policy flexibilities to ease Provider administrative burden at launch and ensure Members receive uninterrupted care as they transition into the Tailored Plan. These flexibilities cover relaxing Medical and Pharmacy Prior Authorizations (PAs); allowing Out-of-Network Provider to Follow In-Network PA Rules and be paid at in-network Rates; and allowing additional Primary Care Provider (PCP) changes.
The Department and the Tailored Plans prioritize Member care and expect all Providers to continue to provide all necessary care to Members throughout the Tailored Plan launch transition period as described in NC Medicaid Provider Bulletin article Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch. This includes, but is not limited to, maintaining scheduled medical care and ensuring access to medications for Members.
NC Medicaid remains committed to working with provider and health plan partners to ensure that medically necessary services are paid for without undue burden to members and providers.
If Providers identify missing authorizations or unexpected denials in the new health plan or experience other potential Member or Provider impacts, please continue services, and reach out to the Tailored Plan assigned to that Member or to the Medicaid Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 919-527-6666.
Additionally, if providers did not initially contract with Tailored Plans, but would like to do so now to serve as the medical home for or to continue to treat newly enrolled Tailored Plan Members, reach out to the Tailored Plan assigned to those Members.
Additional details can be found in the What Providers Need to Know: After Tailored Plan Launch Fact Sheet.
Contact
Tailored Plan contact information is listed on the NC Medicaid Health Plans webpage.