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.