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Clinical Coverage Policies and Provider Manuals
Proposed Medicaid Clinical Coverage Policies
National Uniform Billing Committee (NUBC)
National Uniform Claim Committee (NUCC)
NC Electronic Claims Submission/Recipient Eligibility Verification Web Tool
All Medicaid claims, except inpatient claims and nursing facility claims must be received by HP Enterprise Services [EDS] within 365 days of the first date of service in order to be accepted for processing and payment. All Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim.
Claims for behavioral health services provided to recipients of the Piedmont Cardinal Health Plan (PCHP) catchment area must be filed with the PCHP within 90 days of the date of the service was provided.
All providers who submit claims electronically—whether through a clearinghouse, with software obtained from an approved vendor, or through NCECSWeb—must complete and return an Electronic Claims Submission Agreement to DMA for each billing provider number.
All electronic transactions must be HIPAA compliant. Providers and clearinghouses that bill HIPAA-compliant transactions directly to N.C. Medicaid are required to complete and submit a Trading Partner Agreement (TPA) Form (69 KB PDF) to HP Enterprise Services [EDS].
HP Enterprise Services [EDS] Electronic Commerce Services is available to assist providers with technical support for electronic transactions.
More information about Electronic Commerce Services can be found in Section 10 of the Basic Medicaid Billing Guide.
The NC Electronic Claims Submission/Recipient Eligibility Verification Web Tool is available to providers at no charge. The Web Tool can be used only to bill claims to N.C. Medicaid. Providers are required to receive a logon identification number (also known as an authorization number or submitter ID) and password to the Web Tool. The North Carolina Electronic Claims Submission Web Tool replaces all previous versions of ECS software issued by N.C. Medicaid.
As a cost-saving measure, on October 2, 2009, the N.C. Medicaid Program will require all providers to file claims electronically. However, there are some exceptions to this requirement. Refer to the List of Exceptions for Electronic Claims for information on claims that may be submitted on paper. Only claims that comply with these exceptions may be submitted on paper.
Providers may submit a paper claim (if it is in compliance with the List of Exceptions for Electronic Claims) without an original signature on the claim only if the provider has completed and sumitted a Provider Certification for Signature on File form.
Effective with the second checkwrite in September, the N.C. Medicaid Program will no longer issue paper checks for claims payments. All payments will be made electronically by automatic deposit to the account specified in the provider's Electronic Funds Transfer (EFT) Authorization Agreement for Automatic Deposits.
To initiate the automatic deposit process, providers must complete and return the EFT Authorization Agreement for Automatic Deposit form and attach a voided check to confirm the provider’s account number and bank transit number. A separate EFT form must be submitted for each provider number. Providers must submit a new EFT form if they change banks or bank accounts.
Claims submitted electronically by 5:00 p.m. on the cut-off date are processed on the following checkwrite. Funds are automatically deposited into your account within four days of the checkwrite date.
To check on the status of a claim, call the Automated Voice Response (AVR) System at 800-723-4337.
