Providers are reminded to verify other insurance information for NC Medicaid Managed Care members through the respective Standard Plan and Tailored Plan provider portals or through the PHP’s Real-Time Eligibility Electronic Data Interchange (EDI) transactions 270/271.
NC Tracks should only be used to verify other insurance for NC Medicaid Direct members. NC Medicaid health plans have and will continue to be the primary source of truth for identifying and verifying the existence of other health insurance coverage for the managed care member population. Please refer to the March 2023 bulletin, Identifying Other Found Insurance for NC Medicaid Managed Care Members, for the original announcement.
Other Health Insurance Reminders
- Providers should verify other health insurance information directly with the Medicaid Managed Care Organizations (PHPs) associated with the member prior to submitting claims.
- Claims submitted to a Medicaid PHP for members with other health insurance must adhere to the coordination of benefits (COB) protocols as outlined by the health plan.
Health Plan Responsibilities
- Medicaid PHPs are responsible for identifying, verifying and maintaining accurate records of other health insurance coverage for their members.
- PHPs must communicate any updates of other health insurance to the state Medicaid agency as part of their regular reporting requirements.
Contact
NC Medicaid Help Center: 888-245-0179
Medicaid.HelpCenter@dhhs.nc.gov
NC Medicaid Managed Care Health Plans