NC Medicaid recommends providers and pharmacies use NCTracks Recipient Eligibility Verification/Response to confirm beneficiary eligibility and not rely solely on the information shown on a Member ID card.
Health plans are required to generate an identification card that contains the member’s NC Medicaid Identification number. Some plans include the health plan member ID.
Member ID cards are not required to render services (this includes pharmacies). Therefore, members should not be turned away due to the lack of a Member ID card in their possession.
Follow these steps when an NC Medicaid beneficiary presents at your office:
- Verify eligibility, health plan assignment and primary care provider enrollment using the NCTracks Recipient Eligibility Verification/Response or call the NCTracks Call Center for more information, 1-800-688-6696.
- Confirm your practice participates with the assigned health plan and obtain the health plan member ID to file claims.
- If you are not the assigned Primary Care Practice for the member but are in-network for the health plan, you can render and be paid for Primary Care Services.
- If the member would like to have you as their assigned Primary Care Practice, they should call the Member Services Department for their health plan and ask to be reassigned to you.
Additional resources for providers can be found in the NC Medicaid Help Center and the Provider Playbook: NC Medicaid Managed Care.
Contact
NC Medicaid Contact Center: 1-888-245-0179