KB
What do you use when you can't find the right Knowledge Article?
No Knowledge Found
This is the first thing you say
“Thank you for calling North Carolina Medicaid. My name is (_________).”
“Are you calling on behalf of yourself or someone else?”
Can I receive services from a provider outside my county?
You may choose to see a provider who is outside your county of residence as long as they accept NC Medicaid and will accept you as a patient.
As a Provider, what should I do if I have questions about Managed Care clinical coverage?
"Mr./Ms. (last name), for questions regarding clinical coverage policies for a member enrolled in Managed Care, you will need to contact the provider services line for the health plan. Which health plan are you trying to reach?"
There are 2 ways to search for a recipient.
What is search for a participant and search for a person
I no longer have Medicare coverage. How do I get Medicare removed from your system?
To remove Medicare from our system, please contact your Local Department of Social Services (DSS) office.
This is what you do when Someone has never called before and they are not in the system.
Create New Medicaid Contact Center Case
I received a Happy Birthday Letter, what does this mean?
Mr./Ms. (last name), this letter is sent out to all beneficiaries on their birthday as a reminder to make an appointment for an annual checkup with their PCP if they have not already made an appointment. If you have not seen the PCP listed on your letter it is very important that you make an appointment to establish a patient record. Also remember to take your Medicaid card with you every time you see your PCP. If you cannot keep an appointment, please call the PCP's office before the appointment to tell them.
As a Provider, who can I contact about enrollment, credentialing, or National Accreditation
"Mr. /Ms. (last name) In order to better assist you, I will need to refer you to the NCTracks Call Center for more information on enrollment or credentialing. You can update your information in the NCTracks provider portal at www.nctracks.nc.gov or by calling them at 800-688-6696.”
When looking up a case worker this is the number you are looking for.
What is an integrated case ID.
Inform Caller: “Mr./Ms. (last name), for questions regarding repairs to your medical equipment you will need to contact your health plan (insert plan name). Their telephone number is (insert plan phone number)."
How do I get my Durable Medical Equipment repaired?
Beneficiary
Authorized Representative
Provider/Facility
Local Agency
Other
What are the options for "Reported By"
Who is my Primary Care Provider (PCP) if I am in Managed Care?
As an Out-of-State Provider, how can I provide care to a North Carolina Medicaid Beneficiary?
"Mr./Ms. (last name) in order to submit claims for NC Medicaid beneficiaries you must enroll with NC Medicaid. For any questions regarding the enrollment process you may contact the NCTracks Call Center, their telephone number is 800-688-6696."
this is one of the reasons we use FAST.
What is to change a PCP?
Mr./Ms. (last name), In general Medicaid children under the age of 21 are covered for visits to their primary care provider or a specialist. They have coverage for dental, optical, mental health, medical equipment and prescriptions.
What is the Medicaid Coverage for a child?
When you fill in this and hit save it will populate your KA
What is short description
How do I confirm or change my Medicaid Primary Care Provider (PCP)?
Inform the customer: "Mr./Ms. (last name), I would be happy to assist you with making this change, but there is some information that I would need in order to make the change. I will need the following information:
Provider experiencing payment denials or delays
Inform Caller: “Mr./Ms. (last name), I am sorry to hear that you are experiencing payment issues. There are some steps you can take to reduce claim denials and payment delays, there is bulletin titled: Guidance for Providers Experiencing Payment Issues located on the Medicaid website that will provide you with guidance on ”
This is what displays in the search results.
What is Name, role, D.O.B. and address?
Inform Caller: "Mr./Ms. (last name), for questions regarding clinical coverage policies for a member enrolled in Managed Care, you will need to contact the provider services line for the health plan.
As a Provider, what should I do if I have questions about Managed Care clinical coverage?
These are the last 4 things you say to close the call.
“What we did today was …”
Offer Case number
“If you or your family has recently changed their address or phone number, make sure to update your information with the county Department of Social Services. The address is used to send important documents and information. Do you need the phone number for your local Department of Social Services office to update that information?”
Provide Closing Statement
I was recently Incarcerated, why are my Claims being Denied?
"Mr./Ms., (last name), the living arrangement on your account currently reflect you being incarcerated. You will need to contact your case worker at the local Department of Social Services (DSS) to have the living arrangement changed."
As a Provider, I have questions about Managed Care claims payment or adjudication?
"Mr. /Ms., For specific information on claims reimbursements for managed care beneficiaries, you will need to contact the beneficiaries PHP. You are able to identify the beneficiaries PHP by performing an Eligibility Inquiry in the NC Tracks Provider Portal and locating the Managing Entity information listed in the Health Plan section on the beneficiaries file.
This is where I would find the authorized representative.
What is select the client contact tab and then select contact?