Provider resources

Access helpful resources to help members interested in Healthy Blue Care Together — North Carolina’s Children and Families Specialty Plan.

A collaborative approach to social services

 

Local Department of Social Services (DSS) offer programs and services to help people and families achieve self-sufficiency and well-being. Through a collaborative approach with DSS and other family-supporting agencies, Healthy Blue Care Together is committed to providing access to trauma-informed, comprehensive treatments and services that support children, youths, and young adults in achieving family preservation, timely permanence, and whole-health outcomes that increase well-being.

 

Reporting abuse

 

Provider agencies are required to report any suspicions of abuse, neglect, dependency, or exploitation of a child or adult to the local DSS. In addition, health care facilities and providers are required to report personnel who are alleged to have committed abuse, neglect, and exploitation toward their clients and patients to the North Carolina Health Care Personnel Registry.

 

 Health Care Personnel Registry

Helpful Documents and Resources

 

Find information for assessing coverage options, guidelines for In Lieu of Services (ILOS) benefits, medical policy documents, and more.

Prior Authorization

 

Use the Healthy Blue Care Together Prior Authorization Request Form for submitting medically necessary services for our members.

 

 HBCT Prior Authorization Request Form

 

To request or check the status of a prior authorization request or decision for a particular member, access our Interactive Care Reviewer (ICR) tool in Availity Essentials. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

 

Log in to Availity 

 

For more information on billing revenue codes for behavioral health, pharmacy, and other services please visit the Healthy Blue Medicaid provider site.

 

Healthy Blue Prior Authorization Requirements 

 

 

Pharmacy

 

For pharmacy prior authorization criteria, please visit the North Carolina Department of Health and Human Services (NCDHHS) page for program specific clinical coverage policies.

Forms

 

If you cannot find a Healthy Blue Care Together form on this page, reach out to your provider relationship management representative or visit the Healthy Blue Medicaid Provider Forms page.

 

 HBCT Residential Placement Universal Referral Form

System of Care (SOC)

 

The System of Care (SOC) approach focuses on improving outcomes for children and families through coordinated, cross-system collaboration. It emphasizes early intervention and shared accountability to enhance child safety and family stability while preventing child abuse and neglect.

 

Children, Youth and Young Adult Centered Care

 

Healthy Blue Care Together uses the System of Care (SOC) approach to support children, youth and young adults receiving physical and behavioral health services by creating a supportive network where people and their natural support systems can set treatment goals and choose from various community-based services. These services involve collaboration with schools, juvenile justice, and child welfare systems.

 

Learn more about System of Care in your Healthy Blue Care Together provider manual.

Critical Incident Reporting

 

Medicaid providers must report incidents involving members receiving mental health, developmental disabilities, or substance abuse services. NCDHHS uses an online system called the Incident Response Improvement System (IRIS) to report and monitor such incidents.

 

To report an incident or learn more about provider reporting and incident types, visit the Critical Incident Reporting page on the Healthy Blue Medicaid provider site.

 

Critical Incident Reporting 

Educational Resources and Training Opportunities

 

We offer training opportunities for providers on a variety of topics to help members in their social, physical, and mental health journeys.

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Provider Training Academy

 

For additional training, visit the Training Academy.

 

Access more training