NC Medicaid Eligibility Verification for Behavioral Health
For a North Carolina behavioral health practice, an eligibility check has one job beyond confirming coverage: telling you which of three doors the member walks through. A Standard Plan, a Tailored Plan, and NC Medicaid Direct each route, authorize, and pay behavioral health differently, and booking a patient with a clinician who is not contracted with their door is how most NC intake problems start.
Short answer
Verify NC Medicaid eligibility in NCTracks, through the Recipient Eligibility Verification function in the secure Provider Portal, the Automated Voice Response System, or an electronic 270/271 transaction. NCTracks shows the member's health plan and the benefits they are eligible for, including managed care enrollment. For behavioral health, the check should answer which door the member is in, which plan within it, and whether your clinician is contracted and credentialed with that plan.
Where to check
| Method | What it is |
|---|---|
| NCTracks Provider Portal | Recipient Eligibility Verification in the secure portal |
| AVRS | NCTracks Automated Voice Response System, by phone |
| 270/271 | Electronic eligibility request and response through your clearinghouse or EHR |
NCTracks Call Center: 1-800-688-6696, as of October 2026. Source: NCTracks.
What the check has to answer
- Which door. A Standard Plan, a Behavioral Health and I/DD Tailored Plan, or NC Medicaid Direct. Tailored Plans serve members with significant behavioral health, substance use, I/DD, or TBI needs, and carry the enhanced behavioral health services.
- Which plan. The specific Standard Plan or Tailored Plan, since each has its own network, authorization rules, and portal. See the plan-by-plan guides linked from the NC billing guide.
- Tailored Care Management. Whether the member has a Tailored Care Management assignment, which NCTracks reports for Tailored Plan members.
- Benefits, not just coverage. NCTracks lists the benefits a member may receive. Confirm the service you plan to deliver falls within them.
What eligibility will not tell you
An active NCTracks record does not mean your clinician can be paid. Network participation is plan by plan, and associate-level clinicians are credentialed plan by plan. The member's plan also decides whether the visit needs prior authorization. See NC Medicaid billing for associate-level clinicians.
Verify at booking, then before each visit
Eligibility can change between booking and the visit, so check both times. Stable's AI receptionist verifies insurance during the booking call or text and books the patient with a clinician credentialed with their plan.
Related: the North Carolina Medicaid billing guide, insurance verification for behavioral health and eligibility denials.
Frequently asked questions
How do I verify NC Medicaid eligibility?
In NCTracks, through Recipient Eligibility Verification in the secure Provider Portal, by phone through the Automated Voice Response System, or with an electronic 270/271 transaction. The NCTracks Call Center is 1-800-688-6696.
Does NCTracks show which Medicaid plan a member is in?
Yes. NCTracks shows the member's health plan and benefits, including managed care enrollment, and for Tailored Plan members it reports Tailored Care Management assignment.
What is the difference between a Standard Plan and a Tailored Plan?
Standard Plans cover most NC Medicaid members. Behavioral Health and I/DD Tailored Plans serve members with significant behavioral health, substance use, I/DD, or TBI needs and carry enhanced behavioral health services. Each routes, authorizes, and pays differently.
Is an active NCTracks record enough to bill?
No. Your clinician must be contracted and credentialed with the member's specific plan, and some services need prior authorization from that plan.
The right door, checked at booking.
See Stable verify an NC Medicaid member's plan during the booking call and book them with a credentialed clinician.
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