Out of State Pharmacy Lists Now Posted & Updated Daily on NCTracks
As a service to both NC Medicaid beneficiaries and providers, NCTracks has created a webpage listing of all enrolled out of state (OOS) pharmacies, categorized by state. To download the list for a particular state, click the corresponding link within the table. This data will be updated daily.
The link can be found on the public facing NCTracks Recipient Portal under Quick Links. Logging into NCTracks is not required to access the Recipient Portal where the Out of State Enrolled Pharmacies List is found.
Notification Required for Change of Ownership
Consistent with state and federal law, NCDHHS requires notification of any change of ownership (CHOW) for providers enrolled as a NC Medicaid provider. The enrolled provider must notify the Department at least 30 days prior to the effective date of any CHOW.
Providers will need to complete the Provider Change of Ownership Disclosure Form. The form is located on the NCTracks Providers webpage under Quick Links.
Once the form is downloaded, the Provider will need to:
- Complete all applicable fields within the CHOW form
- Email the form and any supporting documentation to medicaid.chow.workgroup@dhhs.nc.gov
In addition to submitting the Disclosure Form, both the former and new owner must make changes to the provider’s NCTracks enrollment record. For information regarding the enrollment, termination or modification of the NCTracks Provider Enrollment record due to a CHOW, review the Change of Ownership (CHOW) FAQs and follow the instructions as applicable to the intended structure of the NCTracks enrollment record under the new owner.
NC Medicaid Advisory Committee and Beneficiary Advisory Council – Seeking Input to Improve NC Medicaid
In April 2024, the Centers for Medicare and Medicaid Services (CMS) released its final rule, “Ensuring Access to Medicaid Services.” The new rule requires State Medicaid agencies to create a Medicaid Advisory Committee (MAC) and Beneficiary Advisory Council (BAC) by July 2025. The MAC will replace the current Medical Care Advisory Committee (MCAC). The MAC/BAC are designed to center the lived experiences of beneficiaries, their families and caregivers.
They will provide a more formalized structure for beneficiaries and interested parties to provide feedback to the state about Medicaid. The MAC/BAC will provide insights to NC Medicaid on topics related to program operations and the needs of Medicaid beneficiaries, including:
- Additions and changes to covered services
- Coordination of care
- Quality of Services
- Eligibility, enrollment and renewal processes
- Beneficiary and provider communications
- Access to services
- Cultural competency, language access and health disparity
- Other issues impacting health/medical services
Applications for the MAC and BAC are now being accepted. For questions or additional information, please email Medicaid.NCEngagement@dhhs.nc.gov.
Implementation of Provider Data Management/Centralized Verification Organization on Hold
NCDHHS is pausing the implementation of the Provider Data Management/Centralized Verification Organization (PDM/CVO) module until further notice. While NCDHHS expects to fully implement a PDM/CVO module in the future, providers will continue to use NCTracks for all enrollment activities.
Even though NCDHHS is not transitioning to PDM/CVO at this time, providers remain contractually obligated to:
- Maintain an accurate provider record in NCTracks. Reviewing each provider record and correcting outdated information is essential to supporting beneficiaries and the integrity of NCTracks provider data.
- Respond to NCTracks notifications that require action. Monitor the NCTracks Provider Message Inbox for Reverification, Expiring Credentials, Maintaining Eligibility, and other important notices that require action to continue participation with NCDHHS programs.
- Stay informed. Review the NC Medicaid Provider webpage often and read all new Medicaid bulletins.
- Participate in educational opportunities. Respond to notifications of engagement opportunities, webinars and other events.
NCDHHS will continue to work closely with providers to ensure a smooth enrollment process in NCTracks. The Implementation of Provider Data Management/Centralized Verification Organization on Hold bulletin is available on the NC Medicaid providers webpage. For more information about provider enrollment, visit NC Medicaid’s Provider Enrollment webpage.
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.
- NC Medicaid’s Provider Operations will host a Virtual Office Hours webinar on Dec. 5, 2024, from 12-1 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.
- The next Fireside Chat webinar, hosted by Dr. Janelle White, Chief Medical Officer of NC Medicaid, will take place on Feb. 20, 2025, from 12-1 p.m.
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.
Updated Provider Fact Sheets
NC Medicaid updated Fact Sheets in the NC Medicaid Managed Care Provider Playbook:
- Tailored Care Management NC Medicaid Direct / Managed Care Enrollee Report
- Panel Management for Primary Care Providers
- Request to Move to Tailored Plan
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.
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 webpage.
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.
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