MES PORTAL

The North Carolina Department of Health and Human Services' (NCDHHS) Medicaid Enterprise System (MES) supports the State's Medicaid program through its facilitation of interoperability between Medicaid systems.

MES Modules

A modular MES is made of independent and interoperable modules. An ideal modular system inlcudes cloud-based or COTS-based components.

Medicaid Integration Services

Medicaid modules will exchange the data through MIS. It has Managed File Transfer, MES Landing Page and API components.

Provider Data Management

The new Provider Data Management/ Cred-entialing Verification Organization(PDM/CVO) coordinates provider enrollment, credenti-aling, and ongoing data maintenance as a multi-payer system. Provides a user-friendly initial enrollment web application to apply to enroll you or your organization.

Pharmacy Benefit Administrator

North Carolina Department of Health and Human Services (NCDHHS) Pharmacy Benefit Administrator (PBA) system supports point-of-sale (POS) pharmacy claims processing, medication formulary and utilization management, prior authorization services, drug rebate processing for North Carolina, and custom clinical programs.

Fee-for-service

NCTracks, the multi-payer Medicaid Management Information System for the N.C. Department of Health and Human Services (N.C. DHHS).

Interoperability

The North Carolina Department of Health and Human Services (NCDHHS) Interoperability (IO) System provides for a more seamless flow of data between payers, both within and outside of, the North Carolina Medicaid ecosystem, as well as provides Medicaid Direct members the ability to access their Medicaid information via third party apps. By navigating to this application users will have the ability to action third party applications vetting questionnaires, access the applications for operations and maintenance purposes, or view Interoperability reports.

Encounter Processing

Encounter Processing Systems ingest encounter data from Health Plans (PHP, PIHP) and sends quality transaction feedback back to the plans to ensure appropriate industry standard format.

Data Analytics

Dashboards are data visualization tools which display information on program metrics and key performance indicators (KPIs) various programs in NC Medicaid. Dashboards consolidate, arrange and allow users to interact with numbers and metrics on a single screen.

Electronic Visit Verification

Electronic Visit Verification (EVV) is a telephone and computer-based solution that electronically verifies in-home service visits.

About MES Portal

MES Portal is a gateway for all the Medicaid Modules.

NORTH CAROLINA

MEDICAID ENTERPRISE SYSTEM (MES)