NC Medicaid Contact Center Phone: 888-245-0179. Active Provider Recredentialing Due - August - December 2019. To learn more, view our full privacy policy. State Government websites value user privacy. Medicaid Transformation; Medicaid; Mental Health And Substance Abuse; . Providers with questions about the NCTracks online enrollment application can contact the CSRA Call Center at 800-688-6696; 919-851-4014 (fax), or NCTracksprovider@nctracks.com. An official website of the State of North Carolina, North Carolina Reproductive Health Services, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing, Data Dashboards, Action Plans/White Papers. Application receipts will be acknowledged by email or by mail. Prior approval (PA) is required for many DHB services. NC DHHS: Medicaid - NC DHHS: North Carolina Department of Health and If English is not your first language, we can help. In-home aide services are offered by local service providers supported by the Home and Community Care Block Grant. Providers must submit their applications with a valid email address. Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code. EIS-1105 STATE DATA EXCHANGE (SDX) . Out-of-state (OOS) providers must complete the enrollment process every 365 days. Manuals, Forms, and Guides - Carolina Complete Health 8A-2, Facility-Based Crisis Service for Children and Adolescents. The standardized form includes all information a local DSS needs to begin the financial determination for long-term care as required by the Centers for Medicare and Medicaid Services (CMS). State Government websites value user privacy. Provider Manual. Adult Medicaid. An official website of the State of North Carolina, Program Specific Clinical Coverage Policies, Frequently Asked Questions and Answers - Medicaid Providers, 1L-2, Moderate (Conscious) Sedation, AKA Procedural Sedation and Analgesia (PSA), 13A, Cochlear and Auditory Brainstem Implant External Parts Replacement and Repair, 13B, Soft Band and Implantable Bone Conduction Hearing Aid External Parts Replacement and Repair, 8A, Enhanced Mental Health and Substance Abuse Services, 8A-1, Assertive Community Treatment (ACT) Program, 8A-2, Facility-Based Crisis Service for Children and Adolescents, 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers, 8D-1, Psychiatric Residential Treatment Facilities for Children under the Age of 21, 8E, Intermediate Care Facilities for Individuals with Intellectual Disabilities, 8F, Research-Based Behavioral Health Treatment (RB-BHT) For Autism Spectrum Disorder (ASD), 8I, Psychological Services in Health Departments and School-Based Health Centers Sponsored by Health Departments to the under-21 Population, 8J, Children's Developmental Service Agencies (CDSAs), 8L, Mental Health/Substance Abuse Targeted Case Management, 8N, NC Health Choice Intellectual and Developmental Disabilities Targeted Case Management, 8-O, Services for Individuals with Intellectual and Developmental Disabilities and Mental Health or Substance Abuse Co-Occurring Disorders, 1R-1, Phase II Outpatient Cardiac Rehabilitation Programs, 1R-4, Electrocardiography, Echocardiography, and Intravascular Ultrasound, 3B, PACE (Program of All-Inclusive Care for the Elderly), 3G-1, Private Duty Nursing for Beneficiaries Age 21 and Older, 3G-2, Private Duty Nursing for Beneficiaries Under 21 years of Age, 3K-1, Community Alternatives Program for Children (CAP/C), 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA), 3L, State Plan Personal Care Services (PCS), 1-I, Dietary Evaluation and Counseling and Medical Lactation Services, 2B-2, Geropsychiatric Units in Nursing Facilities, 1S-1, Genotyping and Phenotyping for HIV Drug Resistance Testing, 1S-5, Genetic Testing for Susceptibility to Breast and Ovarian Cancer (BRCA), 1S-7, Gene Expression Profiling for Breast Cancer, 1S-8, Drug Testing for Opioid Treatment and Controlled SubstanceMonitoring, 1M-4, Home Visit for Newborn Care and Assessment, 1M-5, Home Visit for Postnatal Assessment and Follow-up Care, 1M-6, Maternal Care Skilled Nurse Home Visit, 5A-1, Physical Rehabilitation Equipment and Supplies, 1E-2, Therapeutic and Non-therapeutic Abortions, Clinical Coverage Criteria and Prior Approval request forms, 9B, Hemophilia Specialty Pharmacy Program, 9D, Off Label Antipsychotic Safety Monitoring in Beneficiaries Through Age 17, 9E, Off Label Antipsychotic Safety Monitoring in Beneficiaries 18 and Older, Behavioral Health Clinical Edits Criteria - Adults, Behavioral Health ClinicalEdits Criteria - Pediatrics, Hematinics (Procrit, Epogen, Aranesp, Mircera, Retacrit), Migraine Therapy - Calcitonin Gene-Related Inhibitors, Neuromuscular Blocking Agents (Botox, Myobloc, Dysport, Xeomin), Mu-Opioid Receptor Antagonists, Peripherally-Acting (Relistor), Therapeutic Continuous Glucose Monitoring Systems (CGM) and Related Supplies, 1A-2, Preventive Medicine Annual Health Assessment, 1A-4, Cochlear and Auditory Brainstem Implants, 1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment, 1A-6, Invasive Electrical Bone Growth Stimulation, 1A-7, Neonatal and Pediatric Critical and Intensive Care Services, 1A-9, Blepharoplasty/Blepharoptosis (Eyelid Repair), 1A-11, Extracorporeal Shock Wave Lithotripsy, 1A-15, Surgery for Clinically Severe or Morbid Obesity, 1A-20, Sleep Studies and Polysomnography Services, 1A-21, Endovascular Repair of Aortic Aneurysm, 1A-23, Physician Fluoride Varnish Services, 1A-24, Diabetes Outpatient Self-Management Education, 1A-32, Tympanometry and Acoustic Reflex Testing, 1A-33, Vagus Nerve Stimulation for the Treatment of Seizures, 1A-36, Implantable Bone Conduction Hearing Aids (BAHA), 1A-39, Routine Patient Costs Furnished in Connection with Participation in Qualifying Clinical Trials, 1A-41- Office Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone, 1C-2, Medically Necessary Routine Foot Care, 1K-7, Prior Approval for Imaging Services, 1-O-1, Reconstructive and Cosmetic Surgery, 1-O-5, Rhinoplasty and/or Septorhinoplasty, 1D-1, Refugee Health Assessments Provided in Health Departments, 1D-2, Sexually Transmitted Disease Treatment Provided in Health Departments, 1D-3, Tuberculosis Control and Treatment Provided in Health Departments, 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, 11B-8, Small Bowel and Small Bowel/Liver and Multivisceral Transplants, 10D, Independent Practitioners Respiratory Therapy Services, 11A-1, Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia (ALL), 11A-2, Hematopoietic Stem-Cell Transplant for Acute Myeloid Leukemia, 11A-3, Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia, 11A-5, Allogeneic Hematopoietic Transplant for Genetic Diseases and Acquired Anemias, 11A-6, Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors, 11A-7, Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma, 11A-8, Hematopoietic Stem-Cell Transplantation For Multiple Myeloma and Primary Amyloidosis, 11A-9, Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes & Myeloproliferative Neoplasms, 11A-10, Hematopoietic Stem-Cell Transplantation (HSCT) for Central Nervous System (CNS) Embryonal Tumors & Ependymoma, 11A-11, Hematopoietic Stem-Cell Transplant for Non-Hodgkins Lymphoma, 11A-14, Placental and Umbilical Cord Blood as a Source of Stem Cells, 11A-15, Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood, 11A-16, Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL), 12B, Human Immunodeficiency Virus (HIV) Case Management, 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, 6A, Routine Eye Exam and Visual Aids for Recipients Under Age 21, 6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older. PDF Claims and Billing Manual - AmeriHealth Caritas North Carolina The provider will be terminated from theNC Medicaid and NCHC programs following 50 days of suspension. Studies show that taking your blood pressure at least twice a month for four months lowers your blood pressure. An official website of the State of North Carolina An official website of NC How you know . PDF Sis100 Instructions for The Sis Client Entry Form Dss-5027 Sis100.01 Program Specific Clinical Coverage Policies | NC Medicaid STATE AND FISCAL AGENT STAFF - Click on the Operations tab above to enter the Operations Portal and . The Settlement provides important protections for North Carolina Medicaid beneficiaries. ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are required to use ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2015. The PCS Provider Manual lists provider requirements and PCS program information in North Carolina. 09-23 . For reimbursement of medical equipment and devices that are not available through an enrolled provider located within NC or in the 40-mile border area. February 2, 2022. To learn more, view our full privacy policy. DHHS currently has eight LME-MCOs operating under the 1915 b/c Waiver. NCTracks Contact Center. Medicaid claims, except inpatient claims and nursing facility claims, must be received by NCTracks within 365 days of the first date of service to be accepted for processing and payment. Welcome to Wellcare; Join our Network; Medicare Resources; Medicaid Resources . Helpful resources. 1 North Carolina Medicaid Provider Resource Guide WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. The NC Medicaid Ombudsman is a resource to help Medicaid beneficiaries learn more about NC Medicaid Managed Care, understand their rights and responsibilities, and receive referrals for other services that they may need. NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2000. State Government websites value user privacy. 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers. REFUGEE HEALTH ASSESSMENTS PROVIDED IN HEALTH DEPARTMENTS. AmeriHealth Caritas North Carolina Providers Provider Manuals and Guides - provider.healthybluenc.com To request an aid or service, please call Carolina Complete Health Member Services at1-833-552-3876 (TTY 711). Learn about available programs and services, if youre eligible and how to apply. Join our network. 8A-1, Assertive Community Treatment (ACT) Program. To learn more, view our full privacy policy. To receive . The first notification is sent to the providers Message Center Inbox 70 days prior to the provider re-credentialing due date. You can request free auxiliary aids and services, including any material offered electronically and other information in large print. State Government websites value user privacy. Claims are processed in real time. North Carolina Medicaid uses the resources and partnerships of Medicaid to improve health care for all North Carolinians. "Active" patients . Our Provider Support Service Line is available for our network serving our populations in North Carolina. Providers who do not complete the recredentialing process on time will be suspended from Medicaid program participation. Visit RelayNCfor information about TTY services.