• DMA HOME

• ABOUT DMA
• CONTACT DMA

 

Claims and Billing

Budget Initiatives

DMA will implement a number of changes in response to legislated budget reductions. Read more about budget initiatives > >

Submitting Claims to Medicaid

• Claims: Time limits, claims payment, adjustments, and other topics of interest to billers and providers.
• List of Exceptions for Electronic Claims (Claims that Must be Submitted on Paper)
• Correct Coding - NCCI and Additional Edits

Annual Visit Limitation

• Annual Visit Limits for mandatory and optional services.
• Requesting an Exception

Recipient Eligibility Verification

• Recipient Eligibility Verification: What needs to be verified and tools that can be used to verify a recipient's eligibility

Prior Approval

Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. Read more about prior approval > >

The Medicaid Recipient Due Process Rights and Prior Approval Policies and Procedures (PDF, 157 KB) documents the instructions for Medicaid recipient due process rights and prior approval procedures for N.C. Medicaid providers and all agency staff and contractors that perform utilization review functions on behalf of DMA.

Third-Party Insurance

• Third-party Insurance: Third-party insurance codes, forms, and requirements for billing Medicaid.

Medicaid Management Information System (MMIS)

In December 2008, the N.C. Department of Health and Human Services awarded a contract to CSC to develop and implement a replacement Medicaid Management Information System (MMIS) in support of health care administration for multiple DHHS agencies, including DMA. Read more about the replacement MMIS > >

Electronic Health Record Incentives

The American Recovery and Reinvestment Act of 2009 provides for the promotion of electronic health records (EHR) through incentives. Read more about EHR > >