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Claims and BillingNC Medicaid 2025

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The document outlines the procedure for submitting a request to terminate orthodontic treatment under the North Carolina Medicaid Program. It includes instructions for electronic submission via the NCTracks Prior Approval Portal, required documentation such as treatment notes and photographic images, and details on reasons for termination. Additionally, it mentions potential refund requirements for banding fees based on individual case circumstances.

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Versions	Form popularity	Fillable & printable
2020	4.7 Satisfied (29 Votes)
2009	4 Satisfied (47 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

When billing Medicaid claims, which procedures are important?

Final answer: When billing Medicaid claims, important procedures include ensuring patient financial eligibility, checking if there is additional insurance coverage, and billing Medicaid as secondary payer if there is other insurance.

What is the CMS definition of incident to?

INCIDENT TO FACT SHEET. What is incident to? Services that are performed per the direction of a physicians treatment plan during the course of a professional service.

What is incident to billing North Carolina Medicaid?

What is incident-to billing? In colloquialism, incident-to billing allows non-physician providers (NPPs) to report services as if they were performed by a physician. The NPP stands in the shoes of the physician.

What does incident 2 billing mean?

What is incident-to billing? Incident-to billing allows NPPs to provide follow-up services under the direction of a supervising physician and bill under the doctors national provider identifier (NPI) number, resulting in a greater Medicare reimbursement rate.

What is timely filing for claims for Medicaid in NC?

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. Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim.

What documentation is required for incident to billing?

Documentation Requirements: Identify the individual who rendered the service. Document physicians presence in the office at the time of the service. Indicate supervision requirement is met. Document supervising physicians physical presence in the office suite.

What are the new Medicaid rules in NC?

Starting on December 1, 2023, NC Medicaid will cover people ages 19 through 64 years with higher incomes. You may be able to get health care coverage through Medicaid even if you didnt qualify before.

What is the difference between direct billing and incident to billing?

Direct billing is when they bill directly under their respective Medicare National Provider Identification (NPI) number. When billing incident to, the NP or PA is not identified to the patient or the insurance company on the bill. Only the physician is credited for the appointment under their NPI number.

Claims and BillingNC Medicaid 2025

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