Transition of Care: Requests to Move to NC Direct or LME-MCO
When providers have identified that a member requires specific services that are not covered by the Standard Plan, providers can submit a Request to Move to NCĀ MedicaidĀ Direct orĀ LME-MCOĀ form to theĀ enrollmentĀ broker. This form can beĀ submitted digitallyĀ or by calling theĀ enrollmentĀ broker at 833-870-5500 to request a downloadable form version that can be mailed or faxed.
This form can be used for two types of submissions, service associated requests and non-service associated requests. A service associated request is submitted by a provider with the beneficiaryās consent requesting specific services only available through theĀ LME-MCO. It isĀ requiredĀ that a Service Authorization Request (SAR) (also known as a Treatment Authorization Request), and necessary supporting documentation is submitted with service associated requests.
For purposes of this transition, Alliance Health has developed aĀ Transition of Care Service Authorization Request formĀ that can be attached to the request to move form. Once the request to move form is received by Alliance Health, theĀ Utilization ManagementĀ Department will create a service request on behalf of the providers for purposes of a medical necessity review.
