​Medicaid Managed Care: Claim Submission and Prior Authorization Clarifications

To provide some clarity on prior authorization submissions, NCDHHS issued a NC Medicaid Managed Care Provider Update on Friday July 9, 2021 that includes  information about claims submission and prior authorizations under Medicaid managed care.  

Provider Prior Authorizations 

If a prior authorization was previously obtained by your practice for Medicaid members prior to the go-live of July 1, 2021, the prior authorization has been sent from the State to your health plan and no further action is needed. 

Health plans are receiving prior authorization requests that were previously submitted and approved by the DHHS. Please do NOT submit a prior authorization if one was already approved by the State. If a practice wants to verify a health plan has received a prior authorization, please contact the health plan provider relations team directly at: 

• AmeriHealth Caritas:  Provider Services: 888-738-0004  
• Carolina Complete:  Provider Services: 833-552-3876  
• Healthy Blue: Provider Services: 844-594-5072
• United Healthcare: Provider Services: 800-638-3302  
• WellCare: Provider Services: 866-799-5318  

For more information about prior authorization, see the Managed Care Claims and Prior Authorization Submission fact sheets under Programs and Services. 

Help Center Available for Providers to Find Information 

The NC Medicaid Help Center is an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. To use this new tool: 

1. Go to NC Medicaid Help Center 
2. Type a topic or key words into the search bar 
3. Select a topic from the available list of categories 

Detailed information about the NC Medicaid Help Center is available in a Medicaid Bulletin updated on June 17, 2021. 

Contact: 

NCTracks Contact Center: 800-688-6696