North Carolina Medicaid Management
Information System (NCMMIS)
JOB AID
A+KIDS Drug Type Forms
OVERVIEW
Changes in the NC Medicaid and NC Health Choice Prior Approval (PA) Criteria include:
 The Antipsychotic Safety Monitoring in Children through Age 17 (A+KIDS) drug class paper
forms are now discontinued.
 A+KIDS prior approval request can be submitted via the NCTracks secure portal. A+KIDS
records submitted from Infina will be rejected and returned to Infina as errors.
Note: If the user has any questions regarding submitting an A+KIDS Pharmacy Prior
Approval request, the user can contact the pharmacy prior approval call center at 1-866-2468505 to submit the request by phone. The user should also discard all printed and/or saved
copies of the A+KIDS drug class paper form(s).
This job aid provides instruction on how to access the A+KIDS drug type forms via the
NCTracks secure provider portal.
Note: The user can follow the link listed below in order to review the Prior Approval Drugs and
Criteria for specific drugs prescribed to N.C. Medicaid and Health Choice recipients:
https://www.nctracks.nc.gov/content/public/providers/pharmacy/pa-drugs-criteria-newformat.html
Access Prior Approval Entry Functions
The NCTracks Home page displays once you are logged into the system.
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Step
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Action
Click on the Providers tab.
Click on NCTracks Secure Portal Login.
Job Aid ‒ A+KIDS Drug Type Forms
AKIDS NCTracks Training Document
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North Carolina Medicaid Management
Information System (NCMMIS)
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Step
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Action
Enter the User ID (NCID).
Enter the Password.
Click Log In.
Prior Approval Entry
On the Provider Portal screen, you will access the Prior Approval functions through the Prior
Approval tab.
1
Step
1
Action
Click on PA Entry to complete a Prior Approval entry.
 PA Entry: This function allows users to enter Prior Approval requests.
Job Aid ‒ A+KIDS Drug Type Forms
AKIDS NCTracks Training Document
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North Carolina Medicaid Management
Information System (NCMMIS)
Prior Approval Request
On the Prior Approval screens, the user is able to view Payer, Health Plan, PA Type, and Drug
Type as well as enter and view recipient demographics.
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Step
Action
Select a Payer.
Click Submit.
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Step
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Action
Select a Health Plan.
Select a PA Type.
Select AKIDS from the Drug Type drop-down list.
Click Submit.
Note: Clicking Submit will take the user to the Prior Approval Request screen, where the user is
able to enter the information necessary to complete the prior approval request.
The A+KIDS paper fax forms have been discontinued; therefore, follow the steps listed above to
access the online A+KIDS drug type forms.
Job Aid ‒ A+KIDS Drug Type Forms
AKIDS NCTracks Training Document
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North Carolina Medicaid Management
Information System (NCMMIS)
A+KIDS Prior Approval Program Changes:

If the A+KIDS prior approval request is for a non-preferred drug BUT with trial and failure of
one preferred drug, the request is approved.

If the Prior Approval request is denied, the recipient will receive appeal rights.
Note: A+KIDS Prior Approval request is approved for a period of six (6) months.
Header Information
For Pharmacy PAs, the Header Information screen mainly focuses on the recipient and the
prescriber.
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Step
Action
Account Information: Verify the account to which the user is associated.
Group: Verify the group to which the user is associated.
NPI/Atypical ID: Select the NPI/Atypical ID for the provider or group from the dropdown list.
Recipient ID: Enter an eligible Recipient ID.
4
Click the Confirm button.
5
Click the Next button.
6
Note: The Prescriber section displays the prescriber as the submitting provider. If the provider
listed is not correct, select a different NPI from the NPI/Atypical ID drop-down list.
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2
3
Job Aid ‒ A+KIDS Drug Type Forms
AKIDS NCTracks Training Document
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North Carolina Medicaid Management
Information System (NCMMIS)
Detail Information
The Detail Information screen varies by drug type. It is extremely important to pay special
attention to this screen because the questions are specific to the selected drug type and the
responses to those questions help guide the automatic
response.
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Step
Action
Job Aid ‒ A+KIDS Drug Type Forms
AKIDS NCTracks Training Document
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North Carolina Medicaid Management
Information System (NCMMIS)
Step
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Action
Detail Information: Answer the question “Is this request for a Non-Preferred Drug?”
appropriately. Complete the Drug Name, Strength, Quantity Per 30 Days, and
Length of Therapy.
Note: Entering the Quantity Per 30 Day and Length of Therapy automatically
calculates the Total Quantity Requested.
Clinical Information: Answer the drug specific questions; some responses may
generate additional questions.
I certify that the information provided is accurate and complete to the best of my
knowledge, and I understand that any falsification, omission, or concealment of
material fact may subject me to civil or criminal liability: Select the checkbox to the
left of the attestation.
Enter the user’s PIN (for assistance with PINs, contact the Office Administrator or
User Administrator for your provider).
Click the Verify button.
Click the Next button.
Note: In the Detail information section, selecting “Yes” or “No” to the question “Is this request
for a Non-Preferred Drug?”, will display drug specific questions in the Clinical Information
section.
Attachments
The Attachments screen allows users to share information related to the PA that has not been
captured through the Header Information and Detail Information screens.
Although the attachment question is a required field, actually submitting an attachment is not.
Select ‘No’ if the PA does not need attachments; select ‘Yes’ to include attachments with the
PA.
1
Step
1
Action
Does this Approval request have any attachments?: Select Yes or No
The Submit button used to submit the PA is located on the Attachments screen. Whether or
not the PA has attachments, the user must navigate to the Attachments screen to submit the
PA.
NCTracks provides three transmission types to deliver attachments. In addition to selecting a
transmission code for each attachment, the application requires an attachment control number
to identify the attachment. Under the Attachment Supplement column, the application displays
additional information needed for the selected transmission code.
Job Aid ‒ A+KIDS Drug Type Forms
AKIDS NCTracks Training Document
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North Carolina Medicaid Management
Information System (NCMMIS)
Transmission Code
Attachment Supplement
Fax
The application provides a fax number to fax the attachment.
Mail
The application provides a mailing address to mail the attachment.
Upload
The application provides an Upload File button to allow the user to
locate and add the attachment to the PA.
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Step
Action
1
Attachment Type: Select the type of attachment that will accompany the PA from the
drop-down list.
2
Transmission Code: Select the delivery mode from the drop-down list.
3
Attachment Control #: Enter a unique identifier for the attachment.
4
Click the Upload File button to search for and select a file to append to the PA (Note:
this button is available when Upload is selected as the Transmission Code).
5
Click the Add button (a paper clip appears to the left of appended attachments).
6
Click Submit.
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AKIDS NCTracks Training Document
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