Guidance for Medicaid Providers Experiencing Payment Issues

From the NC Department of Health and Human Services, Division of Health Benefits

During the transition period after NC Medicaid Managed Care launch, providers may experience payment issues from an increase in claim denials. Providers should take the following actions to reduce claim denials and payment delays:

• Submit claims to the correct payer as described in the Managed Care Claims and Prior Authorizations Submission: What Providers Need to Know – Part 1 Fact Sheet
• Follow PHP claim submission and billing guides referenced in the Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions – Part 2 Fact Sheet
• When a claim gets denied, review the denial reason, the information on the claim, the health plan guidance documents and the Medicaid and NC Health Choice clinical coverage policies to identify and correct provider billing errors
• Contact the health plan using the Day One Provider Quick Reference Guide for claim questions

Please see the Medicaid bulletin Guidance for Providers Experiencing Payment Issues for more information.