Provider Tools
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Medicaid Tools and Information

Useful information for health care providers

The following links and documents provide detailed information on Medicaid policies and programs.

Overview:  If you are new to NC's Medicaid program, please start with this overview.

Medicaid sign up:  Health care providers who have not yet signed up to participate in the NC Medicaid program should go here.

Billing Guide, general: For the best overall guide, please go to the NCTracks Provider Claims and Billing Assistance Guide.  This is a long but readable summary of the program.   You can read the entire manual or just click on the chapters that you find relevant.  If you have read this before, just click on the "Summary of Changes."  The Guide is updated in October and April of each year.

Well Child/Health Check Billing Guide (NC Medicaid): The Billing Guide can be found here.

Medicaid Resource Guide 2012: An online guide to Medicaid resources for CCNC Care Managers, including links to Medicaid policies and procedures.

Medicaid Provider Portal: Login to see patient info can be found here

Medicaid Preferred Drugs List: DMA January 2015 list can be found here

Drugs of Choice (DOC) List: The DOC List was created by Community Care of North Carolina and the North Carolina Physician's Advisory Group in response to requests from prescribers for a "hassle free" list of medications that may be used across payers and the uninsured. All medications listed on the DOC List are designated as preferred medications by NC Medicaid and designated as preferred or tier 1 by BCBS of NC, NC State Health Plan, and NC Health Choice.

Medicaid Prior Authorization Forms: List of medications requiring PA forms, and the forms themselves, can be found here.

Bulletins: providers are strongly encouraged to bookmark the Medicaid Bulletins page to keep apprised of policy and coding changes. You may also find it helpful to sign up for NCTracks Communications.

Consumer Guides:  there is also a wealth of information available in the Medicaid Consumer Guides. (Scroll down just below the Consumer Notices.) Information is separated by population served by the program (e.g., women and children, Aged, Blind and Disabled, etc.)

Misuse of Services:  If you think that you have information on improper activities, please help protect the integrity of the Medicaid program by using this online form to report suspected misuse of services.You may also ask your practice's CCNC care manager to make a "Clinical Integrity" report to the CCNC central office.