Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Prior Authorizations Covered When a Beneficiary Transitions to NC Medicaid Direct
When an NC Medicaid Managed Care member becomes part of a population exempted or excluded, they are disenrolled and transition to NC Medicaid Direct.
NC Medicaid Managed Care Provider Update – Aug. 4, 2021
Key milestones, playbook updates, prior authorizations, FAQs, contracting, ombudsman, webinars and more.
Guidance to Pharmacies Supporting Beneficiaries Transitioning to NC Medicaid Direct
Guidance to pharmacies on prior authorizations that transfer from a health plan to NC Medicaid Direct.
Eyeglasses Prior Approval and Dispensing Fee Claims Submission When a Beneficiary Transitions to NC Medicaid Direct
Providers must submit ALL eyeglasses prior approval requests for NC Medicaid Direct beneficiaries and health plan members to NCTracks.
NC Medicaid EHR Incentive Program Announcements
Three Months Left to Submit Program Year 2021 Attestations and the Security Risk Analysis.
Guidance for Providers Experiencing Payment Issues
Actions providers should take to reduce claim denials and payment delays.
NCDHHS Announces Medicaid Managed Care Regional Behavioral Health I/DD Tailored Plans
DHHS announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans).
Legislation Gives Providers More Time to Connect to NC HealthConnex
This bulletin provides important information regarding changes in the law concerning NC HealthConnex, the state-designated health information exchange.
NC Medicaid Managed Care Quality Strategy Updated
The updated Quality Strategy now incorporates the quality activities of all managed care plans, including the Behavioral Health I/DD Tailored Plans, the Eastern Band of Cherokee Indians (EBCI) Tribal Option and Community Care of North Carolina.
Expedited Hardship Advances for CDSA-Contracted Providers at Risk of Not Meeting Financial Obligations
While NC Medicaid works to resolve issues impeding the billing process for CDSA-Contracted Providers to NCTracks, providers who are at risk of not meeting financial obligations this month as a result of this delay may request a hardship advance to offset the business cost due to pended or denied claims.