NC Medicaid Temporary Flexibilities Due to Hurricane Helene
NC Medicaid is committed to North Carolina's response to and recovery from Hurricane Helene. We are working with county and federal partners to make it faster and easier for beneficiaries to receive - and for health care professionals to provide - Medicaid care and services.
The flexibilities in the Update on NC Medicaid Temporary Flexibilities Due to Hurricane Helene bulletin are effective from Sept. 26, 2024, through Oct. 15, 2024 (unless otherwise communicated by DHHS). This bulletin describes the extension of the flexibilities originally scheduled to end Oct. 2, 2024, for NC Medicaid Direct and NC Medicaid Managed Care, as indicated below. Additional updates will be provided as they become available.
As a reminder, providers should always check NC Medicaid eligibility in NCTracks to confirm beneficiary enrollment in NC Medicaid, especially when the beneficiary presents without a Medicaid ID or their health plan ID card, to determine which health benefit the beneficiary is enrolled in and whether their eligibility remains current.
Provider Ombudsman
The health plan grievance and appeal process for providers 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’ process and should be used only as an escalation after contacting the health plan(s) and seeking guidance through 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 may be autogenerated from ServiceNow to the inquirer’s email or received from a Provider Ombudsman team member assigned to help resolve the inquiry. When the inquiry is considered resolved and closed, a final email with subject line “NC Medicaid Inquiry COM00XXXXX Has Been Closed” will be sent from Medicaid.HelpCenter@dhhs.nc.gov.
NCTracks Multi-factor Authentication Changes Coming Soon
In accordance with the North Carolina Identity Management (NCID) Citizen Identity Project, NCTracks is changing the User Login process and implementing Multi-Factor Authentication (MFA) updates. Please complete the steps listed on the recent NCTracks announcement titled NCTracks Multi-Factor Authentication (MFA) Updates Coming Soon for Individual & Business Users.
If you encounter issues during login or authentication, please contact the Department of Information Technology (DIT) helpdesk at 919-754-6000 or 800-722-3946. For more information and training videos, visit the NCID Citizen Identity Project | NCDIT training page.
Provider Application Exclusion Sanction Questions Reminder
A refresher bulletin article is now available with helpful reminders for providers about how to appropriately disclose on provider application exclusion sanction questions. When the Exclusion Sanction question asks, “Has the applicant, managing employees, owners, or agents ever...”, it must be answered accurately for anyone listed on the application, and regardless of the length of time since the infraction occurred. Failing to inform NC Medicaid through disclosure on the Exclusion Sanction Information page will lead to automatic denial of the application.
For more information, review the Refresher: Be Sure to Disclose on Provider Application Exclusion Sanction Questions bulletin on the NC Medicaid providers web page.
NC Medicaid Webinars
Attending webinars and Virtual Office Hours facilitated by NC AHEC in partnership with NC Medicaid is a great way for providers to stay informed about program initiatives and updates.
- The next Fireside Chat webinar, hosted by Dr. Janelle White, Chief Medical Officer of NC Medicaid, will take place on Nov. 21, 2024, from 12-1 p.m.
- NC Medicaid’s Provider Operations will host a Virtual Office Hours webinar on Dec. 5, 2024, from 5:30-6:30 p.m. These quarterly sessions offer an interactive format for providers to ask questions on a variety of topics, including NC Medicaid Managed Care and provider enrollment.
Visit the NC AHEC Medicaid Managed Care webpage for additional information and registration for upcoming sessions. Recordings, presentation slides, and transcripts from previous webinars are available.
Tailored Plan Launch Flexibilities Extended
NC Medicaid implemented several policy flexibilities at the launch of Tailored Plans to ease the administrative burden on providers and to ensure members receive uninterrupted care during the transition to Tailored Plans. This included relaxing medical and pharmacy prior authorization (PA) requirements and implementing flexibilities for out-of-network provider rates and PA rules.
To ensure continuous care for members during the transition to Tailored Plans and to reduce provider burden, the Department is extending certain policy flexibilities originally scheduled to expire Sept. 30, 2024. The transition period for these flexibilities will continue until Jan. 31, 2025. The full list of flexibilities and their end dates can be viewed in the Policy Flexibilities for Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans Extended.
Changes to Service Location Management Now Effective
Effective Aug. 25, 2024, providers will no longer be able to modify an existing service location address in NCTracks. Instead, a new service location must be created for address changes. The Begin and End date
of the new service location must represent the dates services are rendered at that location. See the full bulletin Upcoming Changes to Service Location Management; Draft Applications to be Deleted.
NCDHHS Announces NC Medicaid Managed Care Children and Families Specialty Plan
The Children and Families Specialty Plan (CFSP) is a first-of-its-kind statewide health plan to ensure access to comprehensive physical and behavioral health services for Medicaid-enrolled children, youth and families served by the child welfare system with seamless, integrated and coordinated care. On Aug. 15, 2024, the first CFSP contract was awarded to Blue Cross Blue Shield NC after a competitive selection process, and the term will last four years.
For more information about CFSP, please visit the Children and Families Specialty Plan webpage.
Updated Provider Fact Sheets
NC Medicaid updated Fact Sheets in the NC Medicaid Managed Care Provider Playbook to reflect the July 1, 2024, launch of Tailored Plans.
- What Providers Need to Know After Tailored Plan Launch
- Tailored Plan Member Enrollment: PCP Auto-assignment
- Tailored Plan Auto-Enrollment & Opt-In Scenarios
- Tailored Plan Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions – Part 2
Stay Informed with NCTracks Provider Announcements
NCTracks Provider Announcements are an important way to stay up to date. Email announcements on a wide variety of topics are regularly sent to enrolled providers and those who join the mailing list, which is open to the public. To sign up for NCTracks announcements, visit the public facing NCTracks Provider Communication page and look for the “Sign Up for NCTracks Communications” section on the right-hand side of the page. An archive of provider announcements is also available on this page.
NC Medicaid Managed Care Information and Resources
Providers are encouraged to remain informed of NC Medicaid Managed Care Transformation through the following resources:
- Medicaid Managed Care Provider Playbook
- Health Plans webpage – Contact information for all health plans, as well as health plan contract requirements and information.
- Financial and Statistical Reports – Contains a variety of dashboards and reports related NC Medicaid activities.
Contacts
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov