NC Medicaid Direct and NC Medicaid Managed Care will reimburse providers for medically necessary drugs and services, and equipment and supplies, provided during the Hurricane Helene emergency without prior authorization (PA) starting September 26, 2024, through October 2, 2024, (unless otherwise communicated by DHHS).
Medical documentation must support medical necessity. In addition, beneficiaries who have been evacuated out-of-state (OOS), voluntarily or involuntarily, can receive medically necessary services and/or care if needed and NC Medicaid Direct and NC Medicaid Managed Care will reimburse the OOS provider without PA. OOS providers must enroll as NC Medicaid providers, and may use an abbreviated OOS Lite enrollment process on the NCTracks Provider Enrollment webpage if full enrollment is not desired.
Providers are encouraged to obtain a PA if it is possible to do so (and normally required for the service). All claims are subject to audit.
Medication PA overrides due to Hurricane Helene
NC Medicaid enrolled pharmacy providers have been approved to override PA requirements starting September 26, 2024, through October 2, 2024, (unless otherwise communicated by DHHS). This override of PA is being allowed to ensure that all Medicaid beneficiaries have access to necessary medications.
Read the full NC Medicaid provider bulletin detailing additional flexibilities here.