Medicaid Bulletin

Key milestones, playbook updates, prior authorizations, FAQs, contracting, ombudsman, webinars and more.

Guidance to pharmacies on prior authorizations that transfer from a health plan to NC Medicaid Direct.

Providers must submit ALL eyeglasses prior approval requests for NC Medicaid Direct beneficiaries and health plan members to NCTracks.

Three Months Left to Submit Program Year 2021 Attestations and the Security Risk Analysis.

Actions providers should take to reduce claim denials and payment delays.

DHHS announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans).

This bulletin provides important information regarding changes in the law concerning NC HealthConnex, the state-designated health information exchange.

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.

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.

Effective June 1, 2021, all personal care services (PCS) claims that were subject to the electronic visit verification (EVV) mandate must include visit data information before the claim can process to adjudication in NCTracks.