New Medicaid Referral Process Effective As of Yesterday, Nov. 1

As noted in an earlier North Carolina Medical Society (NCMS) Bulletin article, the NC Division of Medical Assistance (DMA) recently updated its CCNC/CA referral authorization procedures. The new procedure went into effect yesterday, Nov. 1. Read the special DMA bulletin with the updates here.

Most importantly, DMA dropped its proposal to require all referrals of Medicaid patients by primary care providers (PCPs) in the CCNC/CA networks to be arranged manually and exclusively via the NCTracks portal. In addition, DMA eliminated the requirements that:

  • PCPs must first receive a CCNC/CA authorization (via portal, phone or otherwise) from NCTracks before referring to any specialist;
  • the rendering-specialist must include the NPI of the patient’s PCP on his/her claim for the claim to process and pay; and
  • rendering specialists must request overrides/exceptions by phone if the authorization was not done in advance or there was some related problem.

The umbrella issue of “managed care referrals and overrides” is the highest-volume and longest-running complaint the NCMS has received involving Medicaid since NCTracks came online in 2013, so these are welcome changes.

 
 

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