Clinical Coverage Policies and Provider Manuals
Proposed Medicaid Clinical Coverage Policies
NC Electronic Claims Submission/Recipient Eligibility Verification Web Tool (Note: The Web Tool is only available through Internet Explorer) ![]()
800-723-4337
24 hours a day, 7 days a week*
*Except for system maintenance, 1:00 a.m. to 5:00 a.m. on the 1st, 2nd, 4th, and 5th Sundays of the month and 1:00 a.m. to 7:00 a.m. on the 3rd Sunday
Printer Friendly Version (AVR Cheat Sheet)
The Automated Voice Response (AVR) system allows enrolled providers to readily access detailed information on the following N.C. Medicaid topics using a touch-tone telephone:
Providers are granted access to the AVR by entering either the Medicaid Provider number (MPN) or National Provider Identifier (NPI). Have the required information (below) available before placing your call. Providers are allowed up to 15 transactions per call.
| Transaction | Description | Required Information |
|---|---|---|
| 1 | Verify claim status | MPN or NPI, MID, “from” date of service (DOS), total billed amount |
| 2 | Checkwrite information | MPN or NPI |
| 3 | Drug Coverage | MPN or NPI, drug code, and DOS |
| 4 | Procedure code pricing, CAP pricing, and modifier information | MPN or NPI, procedure code, and type of treatment code or modifier code |
| 5 | Prior approval | MPN or NPI, procedure code, type of treatment code or modifier code, and MID |
| 6 | Recipient eligibility and coordination of benefits; managed care status or hospice status More information on this transaction (PDF, 44 KB) |
MPN or NPI, MID or SSN, DOS, and “from” DOS Note: Response includes CCNC/CA PCP name and telephone number |
| 7 | Sterilization consent and hysterectomy statement | MPN or NPI, MID, and DOS |
| 9 | Repeat options 1 through 7 |
The following table is a reference for using alphabetic data. Use the numeric codes to identify the letters necessary. Be sure to press the asterisk (*) key before entering the numeric codes.
| A –*21 | E –*32 | I –*43 | M –*61 | Q –*11 | U –*82 | Y –*93 |
| B –*22 | F –*33 | J –*51 | N –*62 | R –*72 | V –*83 | Z –*12 |
| C –*23 | G –*41 | K –*52 | O –*63 | S –*73 | W –*91 | |
| D –*31 | H –*42 | L –*53 | P –*71 | T –*81 | X –*92 |