Medicaid Managed Care Provider Update

An update has been published in the NC Medicaid Bulletin for providers with additional information on North Carolina’s transition to Medicaid Managed Care. On July 1, 2021, an estimated 1.6 to 1.8 million Medicaid and NC Health Choice beneficiaries will transition to Medicaid Managed Care. Beneficiaries will be able to choose from five Prepaid Health Plans (PHPs) or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. Some beneficiaries will stay in fee-for-service known as NC Medicaid Direct.

This provider update includes:

  • Links to sign up for one webinar series specifically for Medicaid Managed Care going live on July 1, 2021 and another that focuses on Quality and Performance on clinical criteria
  • How to ensure provider information displays correctly in NC’s Provider Directory Tool
  • Provider Ombudsman contact information
  • PHP Provider Manual updates
  • Key dates for transitioning to Medicaid Managed Care

Additional information for providers transitioning to Medicaid Managed Care will be published in future Medicaid bulletins.