Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
Time Limits For Filing Claims
Medicaid claims, except inpatient claims and nursing facility claims, must be received by NCTracks within 365 days of the first date of service to be accepted for processing and payment. Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim.
NC Medicaid has checkwrites fifty weeks of the calendar year no checkwrites occur the week of June 30 and the week of Christmas. Claims are processed in real time. Please refer to the published NCTracks Checkwrite Schedule for cut-off timing for submitted claims.
Apply For Medicaid In North Carolina
Online at HealthCare.gov or at ePass. You can enroll by phone at 1-800-318-2596. You can also apply in person at your local County Department of Social Services office or complete a paper application.
Eligibility: The aged, blind, and disabled. Also, parents with dependent children are eligible for Medicaid with a household income up to 45% of poverty level, and children are eligible for Medicaid or CHIP with incomes up to 211% of poverty maternity-related coverage is available for pregnant women with incomes up to 196% of poverty.
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Billing Codes For Services Previously Denied
Certain nurse practitioner , physicians assistant and certified nurse midwives services have received denials due to incorrect billing codes since July 2013. NCTracks is updating the claims processing system as inappropriately denied codes are received.
Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code.
The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. Newly identified codes will be addressed as they are received by the NC Medicaid Clinical section.
Move To Managed Medicaid
On September 22, 2015, North Carolina lawmakers passed House Bill 372, known as the Medicaid Transformation and Reorganization Act, to privatize the states Medicaid system then-Governor Pat McCrory signed it into law the next day. Most states were already using Medicaid managed care systems for the majority of their enrollees, but the idea remains controversial.
H. 372 called for the privatization of Medicaid in North Carolina, switching to a model that involves the state contracting with for-profit managed care companies. These managed care organizations, called Prepaid Health Plans , will receive a per-patient payment from the state Medicaid system, and will be responsible for any cost over-runs beyond what they receive up-front from the Medicaid system. This provision is designed to encourage innovation on the part of carriers and providers, in order to keep patients healthy and reduce overall healthcare costs .
Governor Roy Cooper, who was North Carolinas Attorney General at the time, said that turning to MCOs is a risky move.
Medicaid managed care repeatedly delayed took effect in mid-2021
North Carolinas waiver proposal was approved in October 2018, and is effective from 2019 through 2024. Initially, it was to take effect in January 2019, but that was delayed quite a bit.
The state had originally planned to have the managed care transition take effect in , with a phased-in transition .
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Family & Childrens Medicaid
Family and Childrens Medicaid is a health insurance program that serves low-income individuals, children, and parents. For information regarding the different types of Medicaid in North Carolina and to see if you are potentially eligible, visit the Division of Medical Assistance web site at
AM I ELIGIBLE?
- To be eligible for Medicaid, you must be a US Citizen or provide proof of eligible immigration status unless you are only applying for emergency services.
- You must live in North Carolina and provide proof of residency
- You must have a social security number or have applied for one.
- Income and resource limits vary depending on the Medicaid Program and eligibility.
APPLYING FOR FAMILY & CHILDRENS MEDICAID:
- Apply online at
- Apply at Johnston County DSS at 714 North Street Smithfield NC 27577. Applications are taken between 8:00 am to 5:00 pm, Monday Friday
- Mail In Application: https://dma.ncdhhs.gov/medicaid/get-started/apply-for-medicaid-or-health-choice
- Request that an application be mailed to you by calling 919-989-5300
FAMILY & CHILDRENS MEDICAID RECERTIFICATIONS AND CHANGES:
When information is required to complete your FCH Medicaid Recertification, documents must be returned by the due date on the request sent to you. Documents can be mailed in, dropped off using the DSS drop boxes located outside of the DSS building, or dropped off at the inside drop box of building 1.
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Do All Health Plans Offer The Same Services
All health plans offer the same basic benefits and services. Some health plans also offer added services.
Tailored Plans offer certain services that Standard Plans dont have. These include services for a mental health disorder, substance use disorder, intellectual/developmental disability or traumatic brain injury .
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Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
Provider Reverification Requirements To Be Reinstated
With the end of the federal Public Health Emergency expected later this year, NC Medicaid providers will begin receiving reverification notices. These notices will be sent to providers with approaching reverification due dates, as well as those whose reverification was suspended during the federal PHE.
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How To Enroll In Medicaid
To enroll in Medicaid, you must apply with the North Carolina Department of Health and Human Services.
North Carolina Medicaid programs may offer coverage for children, pregnant women, and families with children, the elderly, adults with disabilities, and children with disabilities.
You can apply for Medicaid services and enroll in a health plan in several ways:
What Do You Need To Apply For Adult Medicaid
The process of making an application for Medicaid can be complex and require a considerable amount of information. Here is a list of information that may be needed in making an application:
- Recent Medical Bills
- Canceled checks to medical providers
- Health insurance receipts
- Proof of medical transportation costs
- Statements and payments made to medical providers
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North Carolina Medicaid Application
Between 2013 and 2014, Medicaid coverage of the populace in North Carolina remained unchanged at 18 percent. This is largely due to the states refusal to expand the Medicaid program to pay more individuals who get lower incomes. Under the terms of the Affordable Care Act, states have to expand Medicaid to pay these very low income earning individuals. Since, the Supreme Court has raised the requirement and because of this, North Carolina has over 500,000 residents left in the coverage gap. The policy gap represents individuals in the country who make too much income to apply for Medicaid, but too little to afford private health insurance.
Governor Pat McCrory believed Medicaid growth for people from the country, but only with a work requirement attached. Because of forgoing Medicaid growth, the country stands to lose out on as much as $39.6 billion in federal funding. Regardless of the governors resistance, Medicaid growth is preferred by residents of the nation.
Whats Covered Under Medicaid in North Carolina
Whos Covered Under Medicaid
To be able to apply for Medicaid coverage in North Carolina, residents may use four distinct approaches: online at ePass, by phone, with a paper program, or in person at a Social Services office. Online applications can also be taken using healthcare.gov or by phoning 1-800-318-2596.
After the Medicaid Application
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How To Apply For Medicaid In North Carolina
Where do you sign up for Medicaid in North Carolina? may be the top question for individuals seeking Medicaid coverage in the state. To learn how to apply for Medicaid in NC, applicants must find the correct, reliable information. Individuals can apply for Medicaid online, in-person, by mail or on the phone, but the process is generally the same. Petitioners simply need to complete their Medicaid application correctly and accurately in order to be reviewed to receive benefits. Applicants only need to submit one application, and their local county Division of Social Services will determine if they are eligible for Medicaid or the North Carolina Health Choice . There is no deadline to apply for Medicaid in North Carolina. Individuals may apply and receive benefits at any time of the year. Learn where to apply for Medicaid, and get information about alternative application methods by reading the following sections.
How to Apply for North Carolina Medicaid Online
How to Apply for NC Medicaid in Person
How to Apply for North Carolina Medicaid by Mail
How to Apply for NC Medicaid by Phone
Applicants who require help filling out their Medicaid application form can opt to apply for benefits by phone. Petitioners must simply call their local DSS office and inform them that they would like to apply for Medicaid by phone. A caseworker will guide the applicant through the process and also be able to determine whether the applicant qualifies for benefits.
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How Do I Go Paperless
It’s easy to go paperless. Paperless means you stop getting paper letters by mail and get them online instead. You can get an email, text message or both when you have a letter to view online. All of your letters will be online in your NC Medicaid Managed Care account.
Once you enroll in a health plan, you may choose to go paperless. There are three ways to sign up:
- Online: Log in to your NC Medicaid Managed Care account.
- Mobile app: To get the free mobile app, search for NC Medicaid Managed Care on or the App Store.
- Phone: Call us at 1-833-870-5500 . The call is toll free.
You may sign up for emails, text messages or both.
Once you go paperless, you will not get any letters by mail about your health plan. All of your letters will be online in your NC Medicaid Managed Care account.
Going paperless is faster than getting letters by mail. You can view the letters in your NC Medicaid Managed Care account as soon as they are ready, so you do not have to wait for the mail.
Going paperless is also easier. The letters in your NC Medicaid Managed Care account will never be removed, so you do not have to keep copies of letters mailed to you. You can go back to read them in your NC Medicaid Managed Care account at any time.
You may stop going paperless at any time. If you do, you will get letters by mail again.
What Is Nc Medicaid Managed Care
NC Medicaid Managed Care helps you get the most out of your Medicaid benefits. Instead of one Medicaid program, there are health plans to choose from based on your health care needs.
All health plans are required to have the same Medicaid services, such as office visits, hospital services, blood tests, care management and X-rays. Some health plans also offer added services, such as programs to help you quit smoking, eat healthier and have a healthy pregnancy.
Each health plan has its own network of qualified doctors and health care professionals . All health plans must have enough providers for the covered services you need.
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Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
What Is The Nc Medicaid Ombudsman
The NC Medicaid Ombudsman helps NC Medicaid and NC Health Choice beneficiaries understand the changes happening as the state moves to NC Medicaid Managed Care. The NC Medicaid Ombudsman helps Medicaid beneficiaries when they cannot solve problems with their provider or health plan. They offer free, confidential support and education about the rights and responsibilities of Medicaid beneficiaries.
The NC Medicaid Ombudsman can help Medicaid beneficiaries get access to health care and connect beneficiaries to resources like legal aid, social services and other programs. To learn more, call the NC Medicaid Ombudsman toll free at 1-877-201-3750, 8 a.m. to 5 p.m., Monday through Friday, except state holidays. Or visit them online at ncmedicaidombudsman.org.
You should call the NC Medicaid Ombudsman when you:
- Are not getting the care you need
- Have questions about a notice or bill
- Have talked with your provider or health care option and cannot solve a problem
- Have questions about the complaint or appeal process
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Family & Childrens Medicaid Or Nc Health Choice
Medicaid for Pregnant Women
Medical assistance is available for pregnant women who fall below the income guidelines. The coverage is for pregnancy related procedures only. Once determined eligible for MPW, the coverage continues through the postpartum period regardless of income or other changes.
Medicaid for Families
Medical assistance for low-income families with children under 19. To qualify the family must meet income guidelines and resource limits . This category includes 19 and 20-year-old individuals that may or may not have a child. Some families may have a deductible to meet before Medicaid coverage begins.
Medicaid for Infants and Children
Medical assistance for children or individuals under the age of 19. There are three different income categories based on the age of the individual. The income limits are highest for very young children. There are no reserve limits or deductibles for this program.
North Carolina Health Choice
Medical insurance administered by Blue Cross Blue Shield. This program is for individuals under age 19 whos income is too high for Medicaid and who do not have private insurance. Depending on the familys income there may be co-payments for prescriptions, doctor visits, and emergency room visits. Some families may need to pay an enrollment fee of $100 maximum before benefits are issued. This enrollment fee covers the child/children for one year.
Medicaid & NC Health Choice
Can I Change My Standard Plan After I Enroll
Most people can change their Standard Plan within 90 days of Standard Plan enrollment.
When you enroll in a Standard Plan, you can change your Standard Plan for any reason within 90 days. After that, you can change your Standard Plan:
- At your Medicaid recertification date
- If you are required to change Standard Plans
- If you have a special or with cause reason, such as:
- You moved out of your Standard Plans service area
- You have a family member in a different Standard Plan
- You cannot get all the related services you need from providers in your Standard Plan, and there is a risk to getting the services separately
- A different health Standard Plan may be better for your complex medical conditions
- Your Long-Term Services and Supports provider is not in your Standard Plan
- Your Standard Plan does not cover a service you need for moral or religious reasons
If you want to change your Standard Plan outside of the 90 days, you can request to change your Standard Plan in one of the following ways:
- Log in to your NC Medicaid Managed Care account. You will need to have your NCID ready in order to log in and request to change your Standard Plan.
- Use this website to submit your form. To learn more, go to Submit forms online.
- Call us toll free at 1-833-870-5500 .
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