Practice Support Update Blog

Medicaid Managed Care: Overview of Provider Directory Flow

Apr 7, 2021 1:54:00 PM / by Practice Support Team

The Medicaid and NC Health Choice Provider and Health Plan Lookup Tool provides an online resource for beneficiaries to use while researching and ultimately selecting a health plan and primary care provider (PCP). 

How does my information get into the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool? 

providerdataflow

 

Daily Data Flow  

This process is a daily process that begins at 5 p.m. and will include data updated by the provider and approved that day. The process ends at midnight when the provider directory tool will display verified data received by the NC Department of Health Benefits. 

How does the enrollment broker access provider information? 

The Enrollment Broker (EB) website has two searchable portals:  

  • A public-facing portal, that includes all active Medicaid and NC Health Choice Providers which does not require a password to view, launched on January 25, 2021 to allow beneficiaries, health plans and providers to become familiar with the online directory prior to open enrollment beginning March 15, 2021.  
  • A secured portal that is used by Medicaid and NC Health Choice beneficiaries for health plan and PCP selection. Search results in this portal will only include active Medicaid and NC Health Choice providers that are designated as Advanced Medical Homes (AMHs) or PCPs. This portal launched March 1, 2021 

For more detailed information view this factsheet. 

 

 

Tags: Medicaid Managed Care, Nc Health Choice

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