Practice Support Update Blog

​Medicaid Managed Care: It’s Here….

Jun 30, 2021 10:00:00 AM / by Practice Support Team

It’s hard to believe the Medicaid Managed Care launch is upon us.  The past year and a half we have experienced many challenges to be sure. You can rest assured your Northwest AHEC Practice Support team is here to help you navigate these changes.  Below are some new resources NCDHHS has provided to help you and your practice as they launch Medicaid Managed Care. 

Answers to your most frequently asked questions can be found in the NC Medicaid Managed Care Provider Update – June 29, 2021 Frequently Asked Questions for NC Medicaid Managed Care.   

Recently updated factsheets in the Provider Playbook include:  


  • MedicaidAug. 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 North Carolina Medicaid or NC Health Choice (or until the end of the authorization period, whichever occurs first)  
  • Sept. 30, 2021 – End of beneficiary choice period. *Exempt beneficiaries can change their health plan at any time. They can also choose NC Medicaid Direct at any time. 


If there are claims for dates of service prior to July 1, 2021, they should be submitted as they are today, through NCTracks or LME-MCOs. For dates of service beginning July 1, 2021, claims routing depends on a beneficiary’s enrollment at time of service and the services provided. Claims for beneficiaries enrolled in NC Medicaid Direct should continue to be submitted to NCTracks. Claims for members enrolled in Medicaid Managed Care should be submitted to the assigned health plan as shown on their member ID card and validated through the NCTracks Recipient Eligibility Verification methods, unless the service provided is a carved-out service. Two Claims Submission Provider Fact Sheets are available on the Provider Playbook that addresses how managed care claims are filed. 

PHP Quick Reference Guides

AmeriHealth Caritas North Carolina 

Carolina Complete Health 

Healthy Blue (Blue Cross Blue Shield) 

United Healthcare Community Plan of North Carolina 

WellCare of North Carolina 


As always, if you have questions and need further assistance contact your Northwest AHEC Practice Support Team. 

Chris Jones, DrPH, MHA 
Practice Support Team Lead  

Ryan D. Wilkins, BS  
Practice Support Coordinator  

Medina Wilson, MBA-HM, CPC, CPPM, CFD  
Practice Support Coordinator  
Tammy Yount, MSHAI, PCMH CCE 
Practice Support Coordinator  

Leslie Doroski McDowell, DNP
Quality Improvement Specialist / Curriculum Developer 


Learn more about  Practice Support


Tags: Medicaid, Medicaid Managed Care

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