What is the Request to Move to NC Medicaid Direct Process?
While physical health services are the same for all individuals with Medicaid, some services for people with an intellectual/developmental disability (I/DD), mental illness, traumatic brain injury (TBI), or substance use disorder are only available in NC Medicaid Direct and/or through the LME/MCOs. The Request to Move to NC Medicaid Direct Process is to be used for beneficiaries currently enrolled in a health plan with NC Medicaid Managed Care who need services only available through NC Medicaid Direct and/or through the LME-MCOs. The Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary form and Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Providers form can be submitted indicating that the beneficiary has used or is in need of services only available through NC Medicaid Direct and/or through the LME-MCOs.
The Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Provider form can be submitted digitally at https://ncmedicaidplans.gov/submit-forms-online or by calling the Enrollment Broker at 833-870-5500 to request a downloadable form version that can be mailed or faxed. This form can be filled out by a doctor, therapist or other I/DD, Mental Health, or Substance Use Disorder provider of the person enrolled in NC Medicaid. This form can be used for two types of submissions, Service Associated Requests and Non-Service Associated Requests.
A service associated request is submitted by a provider with the beneficiary’s consent requesting specific services only available through the LME-MCO. If that provider has a beneficiary that develops behavioral health, substance use disorder, I/DD or TBI support needs that are not available in the Standard Plans, this will allow the beneficiary to move to LME-MCO and/or NC Medicaid Direct system to receive services.
A non-service associated request does not include a service authorization request for services and is either submitted directly by a beneficiary (utilizing the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary form) or by any provider (including the hospital) with the member’s consent. Non-service associated requests are reviewed for approval or denial within eight business days for Beneficiary forms and five business days for Provider forms.
Read more about the Request to Move to NC Medicaid Direct Process in this factsheet.
