The NC Medicaid Ombudsman is an independent organization that provides education, guidance and referrals. We ensure that the more than 2.5 million North Carolinians with Medicaid coverage can access the health services they need. Operating under a “no wrong door” approach, our statewide network of NC Medicaid Managed Care experts is ready to provide confidential support and follow-up to resolve families’ issues. Beneficiaries can call us at 877-201-3750 from 8 a.m. to 5 p.m., Monday through Friday (except for State holidays) or via our website.
Who to call when
Helping beneficiaries navigate the many changes to NC Medicaid is one of our key services. We are here to help you and offer some tips below for Who to call Why and When
NC Medicaid Ombudsman
WHY: We help beneficiaries in NC Medicaid Managed Care and NC Health Choice get the care they need, understand their rights and responsibilities, and access resources like legal aid, social services, housing resources, food assistance and other programs.
WHEN: Contact the NC Medicaid Ombudsman when you:
- Are not getting the care that you need.
- Have questions about a notice or bill you have received.
- Have already talked with your health care provider or health plan and have not been able to solve the problem.
- Have questions about the complaint or appeal process.
HOW: You can contact us by:
Department of Social Services (DSS)
WHY: The local DSS office provides guidance and technical assistance to address issues of poverty, family violence and exploitation.
WHEN: You can call your local DSS to get assistance with:
- Applying for Medicaid
- Questions about Medicaid eligibility
- Questions about type of Medicaid coverage
- Updating a mailing address, phone or language preference on file.
Managed Care Health Plan
WHY: All beneficiaries moving to NC Medicaid Managed Care were enrolled in one of five health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. They either selected a health plan during open enrollment or were auto-enrolled in a plan.
WHO:
You can call your health plan to:
- Ask questions about covered services or health plan incentives
- Change Primary Care Providers (PCP)
- Request Non-Emergency Medical Transportation
- Request a new Medicaid ID Card (If lost or stolen)
Health plan member service hours vary.
NC Medicaid Enrollment Broker Call Center
WHY: The Enrollment Broker provides services to help NC Medicaid beneficiaries learn about their NC Medicaid health care options.
WHEN: You can call the Enrollment Broker to get answers to your questions about NC Medicaid Managed Care. Calls made to the Enrollment Broker are toll-free and can provide more information on:
- Confirming your enrollment status and health plan
- Changing health plans (if eligible)
- If you were enrolled in a health plan but need to keep enhanced mental health, intellectual/developmental disability (I/DD), or substance use disorder services you currently receive through an NC Medicaid LME/MCO
- Questions about a letter or notice you’ve received.
Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday
NC Medicaid Provider Ombudsman
WHY: NC Medicaid created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs.
WHEN:
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To resolve issues that could not be resolved by working directly with a health plan (health plan contact info for providers)To assist providers with Health Information Exchange (HIE) inquires related to NC HealthConnex connectivity compliance and the HIE Hardship Extension process.
- To assist providers with questions regarding contracting and billing. If a provider is experiencing issues with payment or contracting with a health plan, providers should contact the Ombudsman to file a ticket for assistance.
WHERE:
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Ombudsman inquiries, concerns or complaints can be sent to: [email protected]. Providers may call the Ombudsman at 866-304-7062. Monday through Friday 8 a.m. to 5 p.m., (except for state holidays).
Medicaid Contact Center
WHY: Individuals under NC Medicaid Direct who have questions about their benefits coverage can contact the Medicaid Contact Center for assistance.
WHEN:
- The Medicaid Contact Center provides general information, such as a beneficiary’s Medicaid ID number or check their NC Medicaid coverage status, if they are having difficulty getting in contact with their local DSS office.
- Individuals who are enrolled in a health plan but have questions regarding dental and eyeglass fabrication coverage can also contact the Medicaid Contact Center for claims assistance.
WHERE: Phone: 888-245-0179 Monday through Friday from 8 a.m. to 5 p.m., (except for state holidays).
What you can do
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Register for our monthly webinars. Our webinars are designed for Medicaid beneficiaries, health care providers and other Managed Care stakeholders. We’re interactive! Presenters will solicit feedback from attendees about their experiences with Managed Care and answer questions from attendees. Click here to register.
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Request a presentation from the NC Medicaid Ombudsman. Presentations can be tailored to the audience and are available virtually or in person. Visit our website at https://ncmedicaidombudsman.org/for-community-partners/
- Engage with us on social media (see links below)
