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Managed Care to Medicaid

Managed Care to Medicaid Direct

The North Carolina Department of Health and Human Services (NCDHHS) has developed policies and procedures to support beneficiaries who transition between NC Medicaid Direct and NC Medicaid Managed Care delivery systems. The Transition of Care is designed to maintain continuity of care for each beneficiary and minimize the burden on providers during transition. 

Acentra Health will help facilitate the transition of Medicaid services for beneficiaries who disenroll from a managed care plan and return to Medicaid Direct. 

Frequently Asked Questions

Where should I submit the disenrollment form?

Starting Aug. 17, 2023, all LTSS Disenrollment Forms should be sent to Acentra via email to NCLIFTSSTCC@kepro.com with the subject line, ‘Disenrollment Form’.

IMPORTANT: Forms must be sent encrypted.

If a secure email is needed, please send an email, without the form attached, to the email listed above, and indicate that you need a secure email to send a disenrollment form.

When is a disenrollment form required to be completed and sent to Acentra?

A LTSS Disenrollment Form must be processed by a managed care plan and sent to Acentra when:

  1. A member is moving back to Medicaid Direct, and;
  2. Is being disenrolled in the next 30 days, and;
  3. Is receiving LTSS Services.*

*A disenrollment form will be requested from a health plan for members who have been approved to receive CAP services. This submitted form is required whether or not they previously received other LTSS services.

What is the turnaround time on processing a disenrollment form after I submitted it to Acentra?

Acentra processes disenrollment forms within 24 hours, but may take up to 5 business days.

Will Acentra communicate with providers about upcoming disenrollments?

The health plan is responsible for communicating upcoming disenrollments to providers. Acentra will send a courtesy communication to providers who are currently delivering LTSS services to the member and inform them of the planned disenrollment.

What causes a member to be required to disenroll from a managed care plan to Medicaid Direct?

An individual is excluded from managed care and must receive care coverage by Medicaid Direct if any of the following apply, they become medically needy, enter foster care, have an extended stay in a nursing facility 90+ consecutive days, are enrolled in PACE, CAP/C or CAP/DA, or become dually eligible. 

Where can I locate the disenrollment form?

The form can be found on the Acentra website, on the resources and training page under the TCC tab or by simply clicking here:  

Disenrollment Form

 

What information is required on the form for it to be able to be processed?

The following information must be provided on the form in order for Acentra to be able to process it:

  • Disenrollment Reason
  • Disenrollment Date
  • Member’s Name
  • MID
  • Health Plan Name
  • Type of Residence
  • Section B including the NPI
  • Section C if section B indicates Nursing Facility
  • Signature

Where can I get more information about the disenrollment process?

For more information on Transition of Care and Disenrollment, please visit the DHHS website here - https://medicaid.ncdhhs.gov/care-management/transition-care