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Basic Medicaid and NC Health Choice Professional Claims - ncdhhs

Basic Medicaid and NC Health Choice Professional Claims - ncdhhs 2025

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The document provides a comprehensive guide on the billing processes for Medicaid and NC Health Choice professional claims, focusing on electronic claims submission, remittance reports, and resolving denied claims. It outlines the requirements for electronic commerce services, including HIPAA compliance, submission guidelines for both electronic and paper claims, and details on handling adjustments and denials. The document serves as a resource for healthcare providers to navigate the billing system effectively.

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What are the Medicaid plans in North Carolina?

NC Medicaid Managed Care Health Plans AmeriHealth Caritas North Carolina, Inc. Prepaid Health Plan; Statewide. Healthy Blue of North Carolina Prepaid Health Plan; Statewide. UnitedHealthcare of North Carolina, Inc. Prepaid Health Plan; Statewide. WellCare of North Carolina, Inc. Carolina Complete Health, Inc.

Where can you find the North Carolina Medicaid and health Choice clinical coverage policy?

All program-specific Clinical Coverage Policies can be found on the NCDHHS website.

What is DHB in NC Medicaid?

North Carolinas Transformation to NC Medicaid Managed Care On July 1, 2021, most Medicaid beneficiaries began receiving the same Medicaid services under NC Medicaid Managed Care. With managed care, beneficiaries choose a health plan and get care through the health plans network of doctors.

Does Medicaid N.C. accept paper claims?

Filing Claims The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system.

What is NC Health Choice Medicaid?

North Carolinas childrens health insurance plan NC Health Choice will cover children from low-income families that still earn too much to qualify for Medicaid. Who is eligible for NC Health Choice: The childs income must exceed the income limit for Medicaid.

What is the phone number for NC Medicaid claims?

NC Health Choice is a free or reduced cost health insurance program for uninsured children birth through age 18. Who is it for? Children who have family incomes that are too high for Medicaid coverage, but equal to or less than 200% of the federal poverty guidelines.

Basic Medicaid and NC Health Choice Professional Claims - ncdhhs 2025

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