Our Short Series

After obtaining North Carolina Medicaid and Health Choice provider enrollment approval for your agency, there are several important next steps to take:

Enroll with Managed Care Organizations (MCOs)

North Carolina has transitioned to a managed care model for Medicaid, so you'll need to contract with the state's MCOs:

1. Contact the MCOs operating in your service area to initiate the contracting process
2. Complete the credentialing and contracting requirements for each MCO.
3. Negotiate reimbursement rates and terms with the MCOs.

Prepare for Service Delivery

To begin providing services:

1. Develop policies and procedures aligned with Medicaid requirements.
2. Train staff on Medicaid documentation and billing practices.
3. Implement a system for tracking authorizations and service delivery.

Establish Referral Relationships

Build relationships with potential referral sources:

1. Connect with local hospitals, doctors' offices, and social services agencies.
2. Reach out to Area Agencies on Aging and other community organizations.
3. Develop marketing materials highlighting your Medicaid-approved status.

Set Up Billing Processes

Ensure your agency is ready to bill Medicaid:

1. Implement Medicaid-compliant billing software.
2. Train staff on proper coding and documentation for Medicaid claims.
3. Establish a process for verifying client eligibility before providing services.

Ongoing Compliance

Maintain your Medicaid provider status:

1. Stay informed about Medicaid policy updates and changes.
2. Participate in required provider training and education sessions.
3. Prepare for potential audits by maintaining thorough documentation.

Remember that enrolling as a Medicaid provider is just the first step. Ongoing compliance and quality service delivery are crucial for success in the Medicaid system. 

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