Get the free Basic Medicaid and NC Health Choice Institutional Claims - ncdhhs

This document provides detailed guidelines for billing claims to the North Carolina Medicaid Program and NC Health Choice, including electronic submission processes, claim resolving, and remittance

How to fill out basic medicaid and nc

How to fill out Basic Medicaid and NC Health Choice Institutional Claims

1. Gather necessary patient information including their name, address, date of birth, and Medicaid ID number.
2. Obtain the healthcare provider's National Provider Identifier (NPI) and tax identification number.
3. Complete the patient diagnosis codes as per the ICD-10 guidelines in the designated section.
4. Fill out the CPT/HCPCS codes for the services provided during the patient's visit.
5. Document the date of service and ensure that the treatment aligns with the billed services.
6. Include details regarding the patient's insurance coverage, including Medicaid or NC Health Choice specifics.
7. Review the claim form for completeness and accuracy, ensuring all required fields are filled.
8. Submit the claim form through the appropriate electronic submission method or by mail to the designated Medicaid office.

Who needs Basic Medicaid and NC Health Choice Institutional Claims?

1. Individuals with low income who require medical assistance.
2. Children and families who need health coverage options like NC Health Choice.
3. People who need long-term care services and have Medicaid eligibility.
4. Patients receiving treatments that are covered under Basic Medicaid and need institutional care.

People Also Ask about

Is NC Medicaid Direct the same as Medicaid?

NC Medicaid Direct is North Carolina's health care program for NC Medicaid beneficiaries who are not enrolled in NC Medicaid Managed Care. It includes care management by Community Care of North Carolina (CCNC), the primary care case management entity for physical health services.

How do I find out if I have NC Medicaid?

Call your local Department of Social Services (DSS). To find your local DSS, use this directory or call the NC Medicaid Contact Center at 1-888-245-0179 (TTY Relay Services: Call 711) to find the DSS closest to you.

What is NC Medicaid called now?

North Carolina's 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 plan's network of doctors.

Does Medicaid NC 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 the income limit for NC Health Choice?

Who is eligible for N.C. Health Choice for Children? Family SizeAnnual IncomeMonthly Income 1 $22,980 $1,915 2 $31,020 $2,585 3 $39,060 $3,255 4 $47,100 $3,9255 more rows

Is NC Medicaid Direct the same as Medicaid?

NC Medicaid Direct is North Carolina's health care program for NC Medicaid beneficiaries who are not enrolled in NC Medicaid Managed Care. It includes care management by Community Care of North Carolina (CCNC), the primary care case management entity for physical health services.

Did NC Medicaid change?

In December 2023, North Carolina became the 40th state to expand eligibility for Medicaid, opening up the government-funded health insurance program to low-income adults who previously made too much money to qualify.

What is North Carolina's Medicaid program called?

Medicaid Managed Care: The largest NC Medicaid program. People join one of several available standard health plans, officially known as prepaid health plans, or PHPs. Four PHPs are available in all the N.C. counties (with one additional plan also available in a few of the southernmost counties that Access East serves).

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What is Basic Medicaid and NC Health Choice Institutional Claims?

Basic Medicaid and NC Health Choice Institutional Claims are processes through which healthcare providers submit requests for reimbursement for services provided to eligible individuals under the Basic Medicaid and NC Health Choice programs, which offer health insurance to low-income individuals and children.

Who is required to file Basic Medicaid and NC Health Choice Institutional Claims?

Healthcare providers who deliver services to beneficiaries enrolled in Basic Medicaid and NC Health Choice are required to file these institutional claims to receive payment for the services rendered.

How to fill out Basic Medicaid and NC Health Choice Institutional Claims?

To fill out Basic Medicaid and NC Health Choice Institutional Claims, providers must complete the claim form with accurate patient information, service details, billing codes, and other required documentation as specified by the state Medicaid agency.

What is the purpose of Basic Medicaid and NC Health Choice Institutional Claims?

The purpose of Basic Medicaid and NC Health Choice Institutional Claims is to ensure that healthcare providers are reimbursed for services delivered to eligible individuals, thereby supporting access to necessary medical care.

What information must be reported on Basic Medicaid and NC Health Choice Institutional Claims?

Information that must be reported includes the patient's identification details, diagnosis codes, procedure codes, dates of service, provider information, and any additional documentation required by the Medicaid program.