Medicaid Managed Care Payment Issues

Several providers have been having issues in getting Medicaid managed care claims paid by the associated Pre-paid Health Plan (PHP).  If you feel that you have been following the PHP’s process in getting these claims paid, but progress is no longer being made, you can reach out to the Provider Ombudsman.  

The Division of Health Benefits (DHB) created the Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.  

Provider Ombudsman inquiries, concerns or complaints can be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov, or providers may utilize the Provider Ombudsman line at 866-304-7062. The Provider Ombudsman contact information should also be published in each PHP provider manual.  

If you reach out to the Provider Ombudsman, please let Sam Clark know, at samc@nchcfa.org, whether or not the Provider Ombudsman was able to help you get a resolution to your Medicaid managed care claim issues.