NC Medicaid is committed to North Carolina's response to the approaching storms, and 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.
This bulletin describes flexibilities effective Sept. 26, 2025, to Oct. 3, 2025, unless otherwise communicated by North Carolina Department of Health and Human Services (NCDHHS), for the NC Medicaid program including NC Medicaid Direct and NC Medicaid Managed Care, as indicated below. Updates will be provided as they become available.
Flexibilities for both NC Medicaid Direct and NC Medicaid Managed Care
Medication Prior Approval Overrides
Due to the potential for severe weather conditions, NC Medicaid beneficiaries in impacted areas may have difficulty obtaining necessary prior approval for certain medications. To ensure continued access to necessary medications, NC Medicaid enrolled pharmacy providers have been approved to override prior authorization (PA) requirements starting Sept. 26, 2025, to Oct. 3, 2025 (unless otherwise communicated by NCDHHS).
For NC Medicaid Direct
NC Medicaid enrolled pharmacy providers should resubmit these claims with “09” (Emergency Preparedness) in the PA Type Code field to override a denial for prior authorization required. Do not place any values in the Submission Clarification Code field.
Additional questions can be directed to the NCTracks service line at 1-800-688-6696.
For NC Medicaid Managed Care
Providers should contact the pharmacy service line (numbers below) to confirm if additional documentation or process need to be completed to allow for prior authorization overrides due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda).
Standard Plans
- AmeriHealth: 1-866-885-1406
- Healthy Blue: 1-833-434-1212
- Carolina Complete: 1- 833-750-4461
- United Healthcare: 1-855-258-1593
- WellCare: 1-866-799-5318
Tailored Plans
- Alliance Health: 1-855-759-9300
- Partners: 1-866-453-7196
- Trillium: 1-866-245-4954
- Vaya Health: 1-800-540-6083
Early Prescription Refill Overrides
The potential for severe weather conditions may present situations where NC Medicaid beneficiaries in impacted areas may require an early refill of their medications. NC Medicaid enrolled pharmacy providers have been approved to allow early refills of these prescriptions and will follow applicable co-pay requirements. Effective Sept. 26, 2025, to Oct. 3, 2025 (unless otherwise communicated by NCDHHS), early refill is being allowed to ensure that all Medicaid beneficiaries have access to necessary medications.
For NC Medicaid Direct
NC Medicaid enrolled pharmacy providers should resubmit these claims with “09” (Emergency Preparedness) in the PA Type Code field and a valid value for an E.R. override in the Reason for Service, Professional Service and Result of Service fields to override a denial for an early refill. Do not place any values in the Submission Clarification Code field. This allows the beneficiaries to receive their medication during an emergency without using either of their limited-use Submission Clarification Code overrides.
Additional questions can be directed to the NCTracks service line (1-800-688-6696).
For NC Medicaid Managed Care
Providers should contact the pharmacy service line (numbers below) to confirm if additional documentation or processes need to be completed to allow for emergency prescription refills effective due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda).
Standard Plans
- AmeriHealth: 1-866-885-1406
- Healthy Blue: 1-833-434-1212
- Carolina Complete: 1- 833-750-4461
- United Healthcare: 1-855-258-1593
- WellCare: 1-866-799-5318
Tailored Plans
- Alliance Health: 1-855-759-9300
- Partners: 1-866-453-7196
- Trillium: 1-866-245-4954
- Vaya Health: 1-800-540-6083