As your go-to source for information and advocacy on issues concerning your practice, the NCMS is offering resources and a process to help you make the transition to Medicaid managed care. Below you will find a handy list of state and individual health plan resources as well as a special NCMS form to log any specific issues you are encountering during this transformation in how North Carolina delivers Medicaid services.
*Please make sure that your first step is to reach out to the plan itself to log your problem before you share your issue with the NCMS. The NCMS and our partners will give an aggregated list of concerns to health plan representatives to make them aware of widespread issues.*
We will be communicating out resolutions from the plans on these problems within NCMS Morning Rounds, in dedicated emails, and on our website.
Click the button below to share your issue with us.
Medicaid Transformation Resources
- NC Tailored Plans FAQ 022023(pdf)
- NC DHHS Tailored Plan Webpage
- Tailored Care Management Webpage
- LME-MCO Directory
- Tailored Plan Panel Membership 8/26/22
- Tailored Plan Provider Contracting Q&A
- NC AHEC/NC DHHS Webinar Series Webpage
- FACT SHEET: What Providers Need to Know Before Tailored Plan Launch 9/9/22
- 2022 Provider Experience Survey Report
- NC DHHS Medicaid Transformation Webpage
- Provider Ombudsman:
- [email protected]
- 866-304-7062
- Provider Playbook
- Fact Sheets
- Advanced Medical Home Webpage
- FAQ Page
- Fee Schedules
- Trainings
- NCTracks
- Transitions of Care
PDF Downloads
- Day One QRC
- What Providers Need to Know after Go-Live
- Prompt Payment Fact Sheet
- Panel Management for Primary Care Practices Fact Sheet
- Claims and Prior Authorizations Submission Fact Sheet: What Providers Need to Know – Part 1
- Claims and Prior Authorizations Submission Fact Sheet: What Providers Need to Know – Part 2
- Telehealth Program Fact Sheet
- Advance Medical Home Fact Sheet
- Eligibility for Newborns
- Protections for Pregnant Women and Newborns
- Eastern Band of Cherokee Indian (EBCI) Tribal Option Overview
- COVID-19 Member Vaccination Incentive Program Update (12/2021)
- Practice Support and Technical Assistance:
- Quality Improvment_Prenatal Fact Sheet_approved
- Quality Improvment_Diabetes Sheet
- Quality Improvment_Improving Childhood Immunizations-1
Provider Support Number: 888-738-0004
- Provider Manual (PDF)
- Provider Billing Manual (PDF)
- Quick Reference Guide (PDF)
- AmeriHealth NaviNet Portal Page
- AmeriHealth Portal Guide (PDF)
- Provider Newsletter & Updates
- Prior Auth Lookup Tool
- Behavioral Health Toolkit (PDF)
- ACNC Pharmacy Page
- ACNC Clinical Policies Page
- Provider Training Page and Office Hours
- ACNC KNOWN ISSUES TRACKER
Provider Support Number: 833-552-3876
- 2021 Provider Manual (PDF)
- CCH 2021 Provider Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Provider Training Page and Office Hours
- CCH Portal Page
- CCH Provider Updates
- CCH Provider Bulletins/Newsletters
- Prior Auth Lookup Tool
- Behavioral Health Webpage with Toolkits Page
- CCH Pharmacy Page
- CCH Clinical Policies Page
- CCH KNOWN ISSUES TRACKER (KIT)
Provider Support: 844-594-5072
- Provider Manual (PDF)
- Quick Reference Guide (PDF)
- Healthy Blue Availity Portal Page
- Healthy Blue Provider Communications
- Prior Authorization Lookup Tool Page
- Prior Authorization Requirements Page
- Behavioral Health Orientation (PDF)
- Healthy Blue Pharmacy Page
- Healthy Blue Clinical Policy Info Page
- Provider Training Page and Office Hours
- HB KNOWN ISSUES TRACKER
Provider Support: 800-638-3302
- UHC Community Plan Provider Manual (PDF)
- UHC Quick Reference Guide (PDF)
- UHC Portal Page
- UHC Portal Guide (PDF)
- UHC Network Bulletin
- Prior Auth Lookup Tool Login
- Behavioral Health Page
- OptumRx
- UHC Clinical Policy Page for Community Plans
- Provider Training and Education Page
- UHC KNOWN ISSUES TRACKER
Provider Support: 866-799-5318
- Provider Resource Page
- Claims Info Page
- WellCare Quick Reference Guide
- WellCare Portal Resource Page
- WellCare Portal Page
- WellCare Provider Bulletins
- WellCare PA Lookup Tool
- Behavioral Health Page
- WellCare Pharmacy
- WellCare Clinical Policies Page
- WELLCARE KNOWN ISSUES TRACKER
