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Benefits and Services

Alliance Health authorizes an array of Medicaid and non-Medicaid (State-funded) services for individuals with mental illness, substance use disorders, and intellectual and developmental disabilities who reside in Cumberland, Durham, Johnston, Mecklenburg, Orange and Wake counties.

For details on benefit plan coverage, please visit our new Benefit Plan Service Details tool.

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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 NC Medicaid Direct or LME-MCO form to the enrollment broker. This form can be submitted digitally or by calling the enrollment 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 beneficiary’s consent requesting specific services only available through the LME-MCO. It is required 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 a Transition of Care Service Authorization Request form that can be attached to the request to move form. Once the request to move form is received by Alliance Health, the Utilization Management Department will create a service request on behalf of the providers for purposes of a medical necessity review.

This page was last reviewed for accuracy on 08/03/2021