North Carolina Medicaid

NC Medicaid is Moving to Managed Care For guidance on navigating this transition, including how to submit a Prior Authorization for members served under NC Medicaid Managed Care, please visit the NC DHHS provider resource page.

Important Numbers:

NC Medicaid Provider Services 1 (888) 510-1150
Beacon Health Options Automated Faxback Service
(Telephonic Authorization Letter Retrieval)
1 (866) 409-5958

Quick Links

ProviderConnect Log In
PCP Information

Research Triangle Park, NC

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

Since its inception, Beacon Health Options has provided utilization management services based on our belief that the most effective treatment is that which is appropriate to the needs of the person being served, easily accessible, provided by competent practitioners, and conducive to family involvement where possible. Treatment should be based upon best practices in the behavioral health care industry.

North Carolina Medicaid

Beginning January 1, 2002, Beacon Health Options, Inc. entered into an agreement with the North Carolina Division of Health Benefits to provide utilization review services for over 1.3 million of the State’s Medicaid beneficiaries.

As of April 1, 2013, Beacon Health Options, Inc. provides prior authorization for mental health and substance abuse services except for beneficiaries covered under the 1915 (b)/(c) waiver.

Provider communication regarding 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 must submit authorization requests to Beacon Health Options electronically using the Beacon Health Options ProviderConnect web portal. Authorization requests submitted by means other than ProviderConnect on/after October 1, 2011 will be returned Unable to Process.

Providers are encouraged to submit any current clinical information to support the medical necessity of the request in addition to the required documentation outlined by the North Carolina Division of Health Benefits. Additional documentation may consist of Child and Family Team notes, summary of Care Review, copies of assessments/evaluations, etc.

Request Formats

1. ITR

All requests for authorization must be submitted via ProviderConnect.

You are required to complete the ITR for all of the following services:

  • Inpatient Services
  • PRTF Services
  • Residential Services (levels I-IV all bed sizes)
  • Partial Hospitalization
  • Facility Based Crisis
  • Community Support Team
  • Intensive In-Home
  • MST
  • ACTT
  • Psychosocial Rehabilitation
  • Day Treatment
  • SAIOP
  • SA Non-Medical Community Residential Treatment
  • SACOT
  • SA Medically Monitored Community Residential Treatment
  • Ambulatory Detox
  • Medically Supervised or ADATC Detox/Crisis Stabilization
  • Non Hospital Medical Detox
  • Opioid Treatment

2. ORF2

All requests for authorization must be submitted via ProviderConnect.

You are required to complete the ORF2 for all of the following services:

  • Outpatient Services
  • Mobile Crisis
  • Diagnostic Assessment

3. Psychological/Neurological Testing

All requests for authorization must be submitted via ProviderConnect.

You are required to complete the Psychological/Neurological Testing form for all Psychological/Neurological Testing services.

Psychological/Neurological Testing requests must be submitted under the Outpatient Level of Service, Mental Health Type of Service, Outpatient Level of Care, Psych Testing Type of Care on ProviderConnect with the Psychological/Neurological Testing form attached.

Authorization Processes

 Inpatient (General and Free Standing Hospitals)

PRTF

Residential Services (Family and Program Type)

Beacon Health Options provides utilization review for all residential services regardless of bed size for individuals under 21 years of age.
A current Person-Centered Plan is required for all residential services.
See NC DHHS Implementation Update #90 for specific information regarding residential submissions including discharge plan, Comprehensive Clinical Assessment and psychiatric or psychological requirements.

Outpatient Services

For beneficiaries under 21, the first 16 visits of the fiscal year are unmanaged and do not require preauthorization. For beneficiaries 21 and over, the first 8 visits of the fiscal year are unmanaged and do not require preauthorization. If in doubt whether or not a beneficiary has exhausted the unmanaged visits, submit a request for authorization to Beacon Health Options. Service Orders are required to be submitted with all outpatient service requests. The service order is required to be updated annually. A Psychological/Neurological Testing Form is required with all requests for testing.

Enhanced Services

A Person-Centered Plan is required for enhanced services.
Link to PCP Information:

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

Retrospective Reviews

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

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

Beacon Health Options has 60 days to review the requests upon receipt of complete information to ensure prompt processing, please provide both the beginning date and the ending date of the period you would like reviewed.

EPSDT Services

Beacon Health Options conducts medical necessity reviews for beneficiaries under the age of 21, when services are requested that are not covered in the NC State Plan. Service limitations on scope, amount, or frequency described in the coverage policy may not apply if the service is medically necessary.

A Person-Centered Plan is required to be updated for EPSDT requests.
Link to PCP Information:

Customer Service/Provider Relations

Providers may submit consumer-specific inquiries to Customer Service on-line 24/7 via ProviderConnect. Such inquiries will receive an electronic response that will appear in the Inbox of Your Message Center on ProviderConnect. Providers may also contact Beacon Health Options Customer Service for routine inquiries at 888.510.1150 between the hours of 8:00 a.m. and 6:00 p.m.

Regarding inquiry escalation, a provider not satisfied with a response to, or the handling of, an inquiry should gather the pertinent information, call Customer Service, and simply ask to speak to a Customer Services supervisor to resolve the issue.

Provider Number Changes to Completed Authorizations

Upon request, Beacon Health Options will change provider numbers on authorizations in place. Please see the descriptions of each form below and select as appropriate.

Provider Change Attestation Form

Use the Provider Change Attestation Form to request provider change only for those Medicaid beneficiaries who have appealed an adverse decision, or whose provider agency is going out of business, or are changing providers for another service with an authorization period of six months or more.

Provider Change Due to Error or Merger

Use the Error/Merger Provider Change Request Form to request a change in provider number to a completed authorization if correcting a previous submission error or due to a merger/acquisition. The fee is $9.70 for each authorization changed. In order to request such changes, providers must complete the Provider Change Request Form located below and mail a hard copy of the completed form along with a check payable to Beacon Health Options Inc. for the appropriate amount to:

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

The requested changes will be completed within ten business days after receipt of the check and completed form and DMA approval to proceed (extraordinary volumes may require longer). Providers may e-mail questions about this service to Beacon Health Options Customer Service at PSDCustomerService@beaconhealthoptions.com

Provider Training Opportunities

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

For questions regarding NC Medicaid specific information contained on this web page please contact the NC Public Sector Provider Service Department 1-888-510-1150.

Links