Useful tips

Does NC Medicaid require prior authorization?

Does NC Medicaid require prior authorization?

Prior authorization is required for certain drugs prescribed to N.C. Medicaid and Health Choice recipients. Providers may submit requests for approval via fax, phone or the NCTracks secure prior authorization portal.

What does Ncmmis stand for?

North Carolina Medicaid Management July 12, 2021. Information System (NCMMIS)

Is Medicaid retroactive in NC?

Retroactive prior approval is considered when a beneficiary, who does not have Medicaid coverage at the time of the procedure, is later approved for Medicaid with a retroactive eligibility date. Exceptions may apply.

How do I know if my NC Medicaid is active?

To contact the NCTracks Call Center to inquire on recipient eligibility in NC FAST, dial 1-800-688-6696.

What is the CPT code for NC Medicaid?

*93985 and 93986 will require prior approval (PA) through eviCore. Clinical coverage policy 1K-7, Prior Approval for Imaging Services will be updated to reflect this new information. *97129 and 97130 will only be available for beneficiaries under the traumatic brain injury (TBI) waiver.

How to request prior approval for NC Medicaid?

The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. However, providers can also submit paper forms via mail or fax. PA forms are available on NCTracks.

Do you have to have a remark code for NCPDP?

At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). 253 Sequestration – reduction in federal payment 254 Claim received by the dental plan, but benefits not available under this plan.

When did NCPDP change the remark code for DCH A1?

CO 0099 INITIAL CYCLE OF CLAIM SUBMITTED BY DCH A1 Claim/Service denied. This change to be effective 6/1/2007: At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)