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Does N.C. Medicaid cover MRI?

Effective for dates of service on or after July 1, 2021, prior approval (PA) for high tech imaging services (ultrasounds, computed tomography [CT], magnetic resonance [MRI] and positron emission tomography [PET]) will no longer be required for North Carolina Medicaid fee for service (Medicaid Direct) beneficiaries.

Does N.C. Medicaid require prior authorization?

Prior authorization is required for certain drugs prescribed to N.C. Medicaid and Health Choice recipients. Refer to the links below for specific criteria. Providers may submit requests for approval via fax, phone or the NCTracks secure prior authorization portal.

How do I know if I have NC Medicaid direct?

If you are enrolled in NC Medicaid Direct, call the NC Medicaid Contact Center at 1-888-245-0179. If you are not enrolled in NC Medicaid Direct, you may ask to move to NC Medicaid Direct.

Can you bill a NC Medicaid patient for non covered services?

No. The provider cannot bill the Medicaid beneficiary for the private insurance copayment amount unless the Medicaid payment is denied because the service was a non-covered service, and then, only if the provider has advised the beneficiary in advance that the services are not covered.

Does N.C. Medicaid require referrals for specialists?

For the first 60 days, referrals for care are not needed, as all Medicaid enrolled providers are able to see patients regardless of being in-network or out of network with the provider.

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What are the different types of Medicaid in NC?

Within the State of North Carolina, there are actually several different types or categories of Medicaid as well, including: Families with dependent children; infants and children; pregnant women; and aged, blind, and disabled. The eligibility guidelines vary somewhat within the programs.

Does NC Medicaid require prior authorization for ultrasound?

No- ultrasound guided procedures do not require prior auth.

How long does Medicaid approval take in NC?

If you are 65 or older, a child, or caretaker of a child, it can take up to 45 days to process your application. If you are under age 65 and have no child in your care, it can take up to 90 days to process your application. If we need additional information, we will contact you by telephone or mail.

What is the monthly income limit for Medicaid in NC?

Who is eligible for NC Medicaid/Health Choice? Family Size133% of the federal poverty level211% of the federal poverty levelMonthly IncomeMonthly Income1$1,801$2,3902$2,427$3,2203$3,052$4,0508 more rows

How do I check the status of my NC Medicaid application?

Verify eligibility, health plan and primary care provider enrollment using the NCTracks Recipient Eligibility Verification/Response or calling the NCTracks Call Center for more information: 800-688-6696.

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