​Medicaid Managed Care: It’s Here….

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:  

• Panel Management - June 29, 2021 
• Protections for Pregnant Women and Newborns - June 29, 2021 
• Day One Provider Quick Reference Guide - June 29, 2021 
• What Providers Need to Know: Part 2 – After Managed Care Launch - June 29, 2021 

KEY DATES FOR TRANSITIONING TO NC MEDICAID MANAGED CARE 

• 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 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. 

KNOW WHERE TO SUBMIT CLAIMS  

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. 

• Managed Care Claims and Prior Authorizations Submission: What Providers Need to Know - Part 1 - June 14, 2021 
• Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions - Part 2 - June 14, 2021 

PHP Quick Reference Guides 

AmeriHealth Caritas North Carolina 
https://www.amerihealthcaritasnc.com/provider/forms/index.aspx 

Carolina Complete Health 
https://network.carolinacompletehealth.com/resources/manuals-and-forms.html 

Healthy Blue (Blue Cross Blue Shield) 
https://provider.healthybluenc.com/north-carolina-provider/manuals-and-guides 

United Healthcare Community Plan of North Carolina 
https://www.uhcprovider.com/en/health-plans-by-state/north-carolina-health-plans/nc-comm-plan-home/nc-cp-training.html 

WellCare of North Carolina 
https://www.wellcare.com/North-Carolina/Providers/Medicaid 

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  
336-713-7039 
cjones@wakehealth.edu 

 
Ryan D. Wilkins, BS  
Practice Support Coordinator  
336-816-5550 
rdwilkin@wakehealth.edu 
 
Medina Wilson, MBA-HM, CPC, CPPM, CFD  
Practice Support Coordinator  
336-618-0974 
mewilson@wakehealth.edu 
 
Tammy Yount, MSHAI, PCMH CCE 
Practice Support Coordinator  
336-829-9641 
tyount@wakehealth.edu 

Leslie Doroski McDowell, DNP 
Quality Improvement Specialist / Curriculum Developer 
336-972-7852 
ldmcdowe@wakehealth.edu