---
title: "​MMC: Prepaid Health Plan Flexibility for Prior Authorizations During First 60 days after Managed Care Launch  ​"
description: Read more on our blog!
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---

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# Practice Support Update Blog

## [​MMC: Prepaid Health Plan Flexibility for Prior Authorizations During First 60 days after Managed Care Launch  ​](https://go.northwestahec.wakehealth.edu/practicesupport/mmc-prepaid-health-plan-flexibility-for-prior-authorizations-during-first-60-days-after-managed-care-launch)

 Jul 15, 2021 7:15:00 AM / by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team)

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On July 7, 2021 NCDHHS posted an [updated bulletin](https://medicaid.ncdhhs.gov/blog/2021/07/07/prepaid-health-plan-flexibility-prior-authorizations-during-first-60-days-after-managed-care-launch) highlighting flexibilities for prior authorizations during the first 60 days of the transition to Medicaid Managed Care. 

![top view of Medicine doctor hand working with modern computer and smart phone on wooden desk as medical concept-1](https://go.northwestahec.wakehealth.edu/hs-fs/hubfs/top%20view%20of%20Medicine%20doctor%20hand%20working%20with%20modern%20computer%20and%20smart%20phone%20on%20wooden%20desk%20as%20medical%20concept-1.jpeg?width=300&name=top%20view%20of%20Medicine%20doctor%20hand%20working%20with%20modern%20computer%20and%20smart%20phone%20on%20wooden%20desk%20as%20medical%20concept-1.jpeg)NCDHHS continued to receive feedback from NC Medicaid providers indicating confusion about prior authorization requirements during the state’s transition to NC Medicaid Managed Care. The Department shared this feedback with the prepaid health plans (PHPs). In response to these concerns, the PHPs will implement the following solution during the first 60 days after managed care launch to ensure beneficiaries continue to have access to services during this transition without unnecessary interruption.  

Between July 1 and Aug. 30, 2021, medically necessary services that normally require prior authorization will still be reimbursed at 100% of the NC Medicaid fee-for-service rate for both in- and out-of-network providers.  To ensure that providers fully understand each PHP’s prior authorization requirements during the transition, the PHPs will still process and pay for these services if: 

- a provider fails to submit prior authorization prior to the service being provided and submits prior authorization after the date of service, or  
- a provider submits for retroactive prior authorizations.    
  *This exception does not apply to concurrent reviews for inpatient hospitalizations which should still occur during this time period.* 

Beginning Aug. 31, 2021, the PHP may deny payment for services that require prior authorization.  For in-network providers this will apply to those services that normally require prior authorization. Out-of-network providers will need to seek authorizations for all services.  

The Department expects all providers to maintain scheduled medical care for beneficiaries through this transition. 

The Department expects the PHPs and providers to continue to work to resolve any outstanding contracting barriers during this time to mitigate out-of-network challenges.  

Additional details about each PHP’s required authorizations are available here: 

- **AmeriHealth Caritas North Carolina**:    
  Prior Authorization:  [https://www.amerihealthcaritasnc.com/provider/resources/physical-prior-auth.aspx](https://www.amerihealthcaritasnc.com/provider/resources/physical-prior-auth.aspx)   
  Quick Reference Guide: [https://www.amerihealthcaritasnc.com/assets/pdf/provider/provider-reference-guide.pdf](https://www.amerihealthcaritasnc.com/assets/pdf/provider/provider-reference-guide.pdf) 
- **Carolina Complete Health**:    
  Prior Authorization: [https://network.carolinacompletehealth.com/resources/prior-authorization.html](https://network.carolinacompletehealth.com/resources/prior-authorization.html)   
  Quick Reference Guide:  [https://network.carolinacompletehealth.com/content/dam/centene/carolinacompletehealth/pdfs/CCHN-Current-PDF-QRG-Form.pdf](https://network.carolinacompletehealth.com/content/dam/centene/carolinacompletehealth/pdfs/CCHN-Current-PDF-QRG-Form.pdf) 

- **Healthy Blue**:    
  Prior Authorization: [https://provider.healthybluenc.com/north-carolina-provider/prior-authorization](https://provider.healthybluenc.com/north-carolina-provider/prior-authorization)   
  Quick Reference Guide:  [https://provider.healthybluenc.com/docs/gpp/NC\_CAID\_QuickReferenceGuide.pdf](https://provider.healthybluenc.com/docs/gpp/NC_CAID_QuickReferenceGuide.pdf) 

- **United Health Care**:    
  Prior Authorization: [https://www.uhcprovider.com/content/provider/en/prior-auth-advance-notification.html](https://www.uhcprovider.com/content/provider/en/prior-auth-advance-notification.html%C2%A0)   
  Quick Reference Guide:  [https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/nc/training/NC-Medicaid-QRG.pdf](https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/nc/training/NC-Medicaid-QRG.pdf)  

- **WellCare**:    
  Prior Authorization: [https://www.wellcare.com/North-Carolina/Providers/Bulletins/Transition-of-Care-Authorization-Info](https://www.wellcare.com/North-Carolina/Providers/Bulletins/Transition-of-Care-Authorization-Info)   
  Quick Reference Guide: [https://www.wellcare.com/North-Carolina/Providers/Medicaid](https://www.wellcare.com/North-Carolina/Providers/Medicaid) 

 

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- [Value based contracting (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/value-based-contracting)
- [Wellness (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/wellness)
- [advance care planning (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/advance-care-planning)
- [artificial intelligence (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/artificial-intelligence)
- [burnout (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/burnout)
- [chronic conditions (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/chronic-conditions)
- [crisis (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/crisis)
- [finance (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/finance)
- [financial assistance (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/financial-assistance)
- [flu season (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/flu-season)
- [foster care (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/foster-care)
- [funding (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/funding)
- [harm reduction (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/harm-reduction)
- [health careers (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/health-careers)
- [health professionals (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/health-professionals)
- [hospital (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hospital)
- [intake (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/intake)
- [leadership (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/leadership)
- [management (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/management)
- [medical provider (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/medical-provider)
- [memory (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/memory)
- [monoclonal antibodies (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/monoclonal-antibodies)
- [north carolina (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/north-carolina)
- [nurse practitioners (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/nurse-practitioners)
- [payment (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/payment)
- [podcast (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/podcast)
- [prenatal (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/prenatal)
- [psychology (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/psychology)
- [seniors (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/seniors)
- [sexually transmitted infections (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/sexually-transmitted-infections)
- [social justice (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/social-justice)
- [social work (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/social-work)
- [stress (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/stress)
- [students (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/students)
- [technology (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/technology)
- [women's health (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/womens-health)
- [youth (2)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/youth)
- [#syphilis (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/syphilis)
- [988 (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/988)
- [ACA (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/aca)
- [AI (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/ai)
- [CAP (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/cap)
- [CNA (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/cna)
- [CSRS (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/csrs)
- [Case Management (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/case-management)
- [Community Health Worker (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/community-health-worker)
- [Fetal Alcohol Spectrum Disorders (FASD) (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/fetal-alcohol-spectrum-disorders-fasd)
- [Free and Charitable Clinics (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/free-and-charitable-clinics)
- [HEDIS (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hedis)
- [HIPAA (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hipaa)
- [Hardship Exception (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hardship-exception)
- [Healthcare Insights (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/healthcare-insights)
- [Heart Health Now (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/heart-health-now)
- [ICD-10 (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/icd-10)
- [Keeping Kids Well (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/keeping-kids-well)
- [MVP (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/mvp)
- [Medicine (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/medicine)
- [NCPHC (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/ncphc)
- [Nc Health Choice (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/nc-health-choice)
- [Obstetrics (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/obstetrics)
- [PECOS (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/pecos)
- [PPE (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/ppe)
- [PTSD (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/ptsd)
- [Pfizer (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/pfizer)
- [RSV (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/rsv)
- [Relief Fund (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/relief-fund)
- [SAMHSA (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/samhsa)
- [SOGI (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/sogi)
- [STD Update (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/std-update)
- [STUN (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/stun)
- [TPM (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/tpm)
- [access (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/access)
- [aggression (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/aggression)
- [antigen test (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/antigen-test)
- [atrium health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/atrium-health)
- [autism (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/autism)
- [breast cancer (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/breast-cancer)
- [broadband access (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/broadband-access)
- [care transitions (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/care-transitions)
- [carolina access (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/carolina-access)
- [carolina complete (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/carolina-complete)
- [chronic kidney disease (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/chronic-kidney-disease)
- [climate change (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/climate-change)
- [cognitive impairment (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/cognitive-impairment)
- [colon cancer (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/colon-cancer)
- [compliance (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/compliance)
- [conversation (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/conversation)
- [counseling (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/counseling)
- [cultural humility (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/cultural-humility)
- [culture (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/culture)
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- [demographics (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/demographics)
- [discrimination (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/discrimination)
- [diversity and inclusion (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/diversity-and-inclusion)
- [doctors day (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/doctors-day)
- [equity (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/equity)
- [exercise (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/exercise)
- [fda (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/fda)
- [fraud (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/fraud)
- [government shutdown (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/government-shutdown)
- [health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/health)
- [health care (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/health-care)
- [health leadership (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/health-leadership)
- [healthcare (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/healthcare)
- [heart health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/heart-health)
- [hepatitis (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hepatitis)
- [hiring (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hiring)
- [hiv (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hiv)
- [home health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/home-health)
- [homeless (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/homeless)
- [hosar (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hosar)
- [housing (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/housing)
- [human trafficking (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/human-trafficking)
- [hypertension (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/hypertension)
- [implicit bias (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/implicit-bias)
- [infant formula (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/infant-formula)
- [infection (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/infection)
- [infectious disease (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/infectious-disease)
- [internet (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/internet)
- [intervention (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/intervention)
- [lantern (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/lantern)
- [lock your meds (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/lock-your-meds)
- [lung cancer (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/lung-cancer)
- [maternal health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/maternal-health)
- [motivational interviewing (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/motivational-interviewing)
- [nc medical journal (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/nc-medical-journal)
- [oncology (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/oncology)
- [opioid (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/opioid)
- [oral health (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/oral-health)
- [outcomes (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/outcomes)
- [payer contracting (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/payer-contracting)
- [phishing (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/phishing)
- [physical therapy (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/physical-therapy)
- [physician assistant (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/physician-assistant)
- [prediabetes (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/prediabetes)
- [prior authorizations (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/prior-authorizations)
- [race (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/race)
- [referral (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/referral)
- [regulations (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/regulations)
- [remote patient monitoring (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/remote-patient-monitoring)
- [research (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/research)
- [respiratory care (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/respiratory-care)
- [rn refresher (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/rn-refresher)
- [safety (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/safety)
- [scope of practice (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/scope-of-practice)
- [shelter (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/shelter)
- [smoking (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/smoking)
- [support staff (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/support-staff)
- [surgery (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/surgery)
- [surgical services (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/surgical-services)
- [team based care (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/team-based-care)
- [therapy (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/therapy)
- [training (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/training)
- [transgender (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/transgender)
- [tricare (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/tricare)
- [trillium (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/trillium)
- [united healthcare (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/united-healthcare)
- [virtual (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/virtual)
- [winston-salem (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/winston-salem)
- [winter (1)](https://go.northwestahec.wakehealth.edu/practicesupport/tag/winter)

See all

### In Case You Missed It... Check Out These Recent Posts

# About Us

The Northwest Area Health Education Center of Wake Forest University School of Medicine provides and supports educational activities and services with a focus on primary care in rural communities and those with less access to resources to recruit, train and retain the workforce needed to create a healthy North Carolina.

[Learn More](https://school.wakehealth.edu/Education-and-Training/Continuing-Professional-Education/Northwest-AHEC)

# Links

- [Course Catalog](http://nwahec.org/)
- [Join Our Email List](https://share.hsforms.com/16F72ZaBBRBqAda7M--9l9w4ewk6)
- [About Northwest AHEC](https://school.wakehealth.edu/education-and-training/continuing-professional-education/northwest-ahec)
- [Continuing Education Services](https://school.wakehealth.edu/education-and-training/continuing-professional-education/northwest-ahec/continuing-professional-development)
- [Contact Support](https://go.northwestahec.wakehealth.edu/support)

# Contact Us

[ahecmktg@wakehealth.edu](mailto:ahecmktg@wakehealth.edu)

 Medical Center Boulevard  
 Winston-Salem, North Carolina

Copyright 2026 | Designed by [HubSpot](https://www.hubspot.com)

<https://www.youtube.com/user/NorthwestAHEC?sub_confirmation=1><https://go.northwestahec.wakehealth.edu/blog/rss.xml><https://www.linkedin.com/company/8087671><https://twitter.com/NorthwestAHEC><https://www.facebook.com/283682715601><https://www.instagram.com/northwestahec>

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