The 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.

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

NCTracks, the multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NCDHHS), coordinates provider enrollment, credentialing and ongoing data maintenance through web applications, and supports additional fee-for-service operational activities including prior approval and claim adjudication.

The Encounter Processing Systems (EPS) ingests Institutional, Professional, and Pharmacy encounter data from Prepaid Health Plans (PHP) and Prepaid Inpatient Health Plans (PIHP). Encounter data are the records of services delivered to NC Medicaid beneficiaries enrolled in managed care plans that receive a capitated, per-member-per-month payment. These records allow NC Medicaid to track the services received by members enrolled in managed care.

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

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

The PHP Contract Data Utility (PCDU) serves as a centralized platform for the submission, tracking, and validation of contract deliverables and operational reports from Prepaid Health Plans (PHPs). PCDU enables automated workflows for data sharing, quality checks, and file verification, ensuring submissions meet established Department standards. The system supports departmental review and approval processes, helping maintain compliance and accountability across managed care contracts.

The Pre-Admission Screening and Resident Review (PASRR) System manages the screening, evaluation, and review of individuals with mental illness, intellectual disabilities, or related conditions seeking admission to Medicaid-certified nursing facilities. PASRR ensures individuals are appropriately placed and receive the necessary specialized services through structured review and approval workflows between providers and the Department.