How do I update my Medicaid information

North Carolina Medicaid

NC Medicaid Moves to Managed Care For more information on navigating this transition, including submitting prior authorization for members being cared for under NC Medicaid Managed Care, please visit the NC DHHS provider's resource page.

Important numbers:

NC Medicaid Provider Services1 (888) 510-1150
Beacon Health Options Automated faxback service
(Retrieving the telephone authorization letter)
1 (866) 409-5958

Quick links

ProviderConnect login
PCP information

Research Triangle Park, NC

Beacon Health Options' North Carolina Engagement Center (NCEC) in Morrisville, NC has been part of the North Carolina mental health and substance abuse service delivery system since 1992.

Since its inception, Beacon Health Options has provided usage management services based on our belief that the most effective treatment will be that which meets the needs of the person being cared for, is easily accessible, provided by knowledgeable practitioners, and is family inclusive wherever possible. Treatment should be based on behavioral medicine best practices.

North Carolina Medicaid

Effective January 1, 2002, Beacon Health Options, Inc. has entered into an agreement with the North Carolina Health Services Department to provide screening services for the use of more than 1.3 million Medicaid beneficiaries in the state.

Effective April 1, 2013, Beacon Health Options, Inc. is granting prior approval for mental health and substance abuse services, with the exception of beneficiaries covered by the 1915 (b) / (c) exemption.

The provider communication for the Medicaid program can be found at www.ncdhhs.gov/dma/index.htm. Service definitions can be found at http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies. Effective October 1, 2011, providers will be required to submit authorization requests electronically to Beacon Health Options through the Beacon Health Options ProviderConnect web portal. Authorization requests submitted on / after October 1, 2011 by means other than ProviderConnect will not be processed.

Providers are encouraged to submit current clinical information to demonstrate the medical need for the request, in addition to the required documentation outlined by the North Carolina Division of Health Benefits. Additional documentation may consist of notes from the child and family team, a summary of the care review, copies of ratings / reviews, etc.

Request formats

1. ITR

All authorization requests must be submitted via ProviderConnect.

  • ProviderConnect login
    For information on ProviderConnect training, see “Training opportunities for providers” below.

You must complete the ITR for all of the following services:

  • Stationary services
  • PRTF services
  • Residential Services (Level I-IV all bed sizes)
  • Partial hospitalization
  • Institution-based crisis
  • Community support team
  • Intense in-home
  • MST
  • ACTT
  • Psychosocial rehabilitation
  • Day treatment
  • SAIOP
  • SA Non-medical residential treatment in the community
  • SACOT
  • SA Medically supervised community treatment in residential areas
  • Outpatient detox
  • Medically supervised or ADATC detox / crisis stabilization
  • Not Hospital Medical Detox
  • Opioid treatment

2. ORF2

All authorization requests must be submitted via ProviderConnect.

  • ProviderConnect login
    For information on ProviderConnect training, see “Training opportunities for providers” below.

You must fill out the ORF2 for all of the following services:

  • Outpatient services
  • Mobile crisis
  • Diagnostic evaluation

3. Psychological / neurological tests

All authorization requests must be submitted via ProviderConnect.

  • ProviderConnect login
    For information on ProviderConnect training, see “Training opportunities for providers” below.

You must complete the psychological / neurological test form for all psychological / neurological tests.

Inquiries about psychological / neurological tests must be submitted to ProviderConnect using the attached form "Psychological / neurological tests" under "Outpatient service level", "Mental health type", "Outpatient service level", "Mental tests" and "Care type".

Authorization processes

Inpatient (general and free-standing hospitals)

PRTF

Residential Services (Family and Program Type)

Beacon Health Options provides a usage review for all residential services regardless of bed size for anyone under the age of 21.
An up-to-date personal plan is required for all residential services.
For specific information on residential filings, including discharge schedule, comprehensive clinical evaluation, and psychiatric or psychological requirements, see NC DHHS Implementation Update # 90.

Outpatient services

For beneficiaries under the age of 21, the first 16 visits of the fiscal year are unmanaged and do not require pre-authorization. For beneficiaries aged 21 and over, the first 8 visits of the financial year are unmanaged and do not require pre-authorization. If in doubt as to whether or not a beneficiary has exhausted the unmanaged visits, submit an application for approval to Beacon Health Options. Service orders must be submitted with all outpatient service requests. The service order must be updated annually. A psychological / neurological test form is required for all test requests.

Advanced services

A personalized plan is required for advanced services.
Link to PCP information:

http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies

Retrospective reviews

Beacon Health Options conducts retrospective reviews of individuals who do not have a detectable, active Medicaid at the time of admission to a service, but are subsequently admitted to Medicaid as of the date of service. Applicable medical records must either be attached to the Retrospective ProviderConnect request or sent via U.S. mail to Beacon Health Options to:

Beacon Health Options, Inc.
Retrospective Review Department
P.O. Box 13907
RTP, NC 27709-13907

Beacon Health Options has 60 days to review requests for full information to ensure speedy processing. Please provide both the start date and the end date of the period you want to review.

EPSDT services

Beacon Health Options will conduct medical necessity reviews for beneficiaries under the age of 21 when requesting services not included in the NC State Plan. Service restrictions on the scope, quantity, or frequency outlined in the Coverage Policy may not apply if the service is medically necessary.

A personal plan must be updated for EPSDT requests.
Link to PCP information:

Customer service / provider relations

Providers can send consumer-specific inquiries to customer service online around the clock via ProviderConnect. Such inquiries receive an electronic response, which is displayed in the inbox of your message center on ProviderConnect. Providers can also contact Beacon Health Options Customer Service at 888.510.1150 between 8:00 a.m. and 6:00 p.m. for routine inquiries

Regarding the escalation of inquiries, a vendor who is not satisfied with a response to or processing of a request should collect the relevant information, call customer service, and simply ask to speak to a customer service representative to resolve the issue.

Changes to the provider number to completed authorizations

Upon request, Beacon Health Options will change the provider numbers of the existing authorizations. Please note the descriptions of the individual forms below and select them accordingly.

Provider Change Attestation Form

Use the Provider Change Attestation form to request a change of provider only for those Medicaid beneficiaries who have appealed against a negative decision or whose provider agency is ceasing to operate or who change providers for another service with an authorization period of six months or more.

Change of provider due to a bug or a merger

Use the Error / Merger Vendor Change Request Form to request a vendor number change to a completed authorization when a previous submission error has been corrected or due to a merger / acquisition. The fee is $ 9.70 for each authorization change. To request such changes, providers must complete the Provider Change Request form below and mail a copy of the completed form along with a check payable to Beacon Health Options Inc. for the appropriate amount to the following address:

Beacon Health Options, Inc.
NC PSD Clinical Director
P.O. Box 13907
RTP, NC 27709-3907

Requested changes will be completed within ten working days of receipt of the check and completed form and DMA approval (exceptional quantities may take longer). Vendors can email questions about this service to Beacon Health Options Customer Service at [email protected]

Training opportunities for providers

Effective October 1, 2011, providers will be required to submit authorization requests electronically to Beacon Health Options through the Beacon Health Options ProviderConnect web portal. See Medicaid Bulletin and August 2011 Implementation Update.
Providers can download ProviderConnect training documents to learn how to submit authorization requests electronically through ProviderConnect. The training documents are:

If you have any questions about NC Medicaid-specific information on this website, please contact the NC Public Sector Provider Service Department at 1-888-510-1150.

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