Provider Playbook: Medicaid Managed Care

This webpage is your "Provider Playbook," a place where you can access the latest information, tools and other resources to help you and your patients smoothly transition to Medicaid Managed Care. Visit the Provider Playbook often as resources will be added as they become available.

    Additional Key Milestone Dates

     

    • June 1, 2021 – Health plan brokers begin scheduling Non-Emergency Medical Transportation (NEMT) appointments for July 1, 2021, or later 
    • June 12, 2021 – Date by which PHPs must distribute welcome packets and ID cards to all beneficiaries entering NC Medicaid Managed Care effective July 1, 2021
    • July 1, 2021 – NC Medicaid Managed Care launch 
    • Aug. 1, 2021 – Beneficiaries have 30 days from the effective date of the AMH assignment (regardless of the notification date) to change their AMH/PCP without cause (1st instance) and shall be allowed to change their AMH/PCP without cause up to one time per year thereafter (2nd instance). In addition, Members shall be allowed to change their AMH/PCP with cause at any time. In year one, most beneficiaries will have until Aug. 1, 2021 to change their PCP/AMH for any reason.
    • Aug. 30, 2021 – Last date by which the health plan will pay claims and authorize services for Medicaid-enrolled out-of-network providers equal to that of in-network providers (or until end of episode of care, whichever is less) 
    • Sept. 29, 2021 – Last date by which the health plan must honor existing and active prior authorizations on file with the North Carolina Medicaid or NC Health Choice program (or until the end of the authorization period, whichever occurs first) 
    • Sept. 30, 2021 – End of beneficiary choice period.

    Contacts

    NC Medicaid Contact Center

    Phone: 888-245-0179

    Provider Ombudsman

    For provider inquiries, concerns, complaints regarding health plans
    Medicaid.ProviderOmbudsman@dhhs.nc.gov
    Phone: 866-304-7062

    NCTracks Call Center

    Phone: 800-688-6696

    Health Plan Contacts and Resources

    https://medicaid.ncdhhs.gov/providers/provider-playbook-medicaid-managed-care