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

A comprehensive guide for billing and submitting claims related to the Basic Medicaid and NC Health Choice programs, covering electronic filing requirements, guidelines for submission, and resolving

How to fill out basic medicaid and nc

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

1. Gather necessary patient information: Name, date of birth, Medicaid ID number.
2. Obtain the provider's details: NPI number, address, and contact information.
3. Select the correct claim form based on the services provided.
4. Fill in the patient's medical diagnosis codes as per the latest coding guidelines.
5. Itemize the services rendered on the claim form, including dates of service and procedure codes.
6. Ensure that you include any required prior authorization numbers, if applicable.
7. Carefully review the claim for accuracy and completeness.
8. Submit the claim electronically or via mail to the designated Medicaid office, depending on state requirements.
9. Retain copies of the claim and any supporting documentation for your records.

Who needs Basic Medicaid and NC Health Choice Professional Claims?

1. Families with low income or limited financial resources.
2. Children under the age of 19 who require medical assistance.
3. Parents or guardians of children who might otherwise go without necessary healthcare.
4. Individuals with disabilities or special healthcare needs.
5. Residents of North Carolina meeting specific eligibility criteria for Medicaid and NC Health Choice.

People Also Ask about

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

What are the rules for Medicaid in NC?

An adult ages 19-64 may be eligible if the family income is $1,800/month or less. An adult ages 65+ may be eligible for full Medicaid if the family income is $1,305/month or less, and for other Medicaid programs if the family income is $1,761/month or less.

Can paper claims be sent to Medicare?

The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Providers meeting an ASCA exception may send their claims to Medicare on a paper claim form. (For more information regarding ASCA exceptions, refer to Chapter 24.)

Why would Medicaid deny a claim?

Medicaid claims often require documentation showing that the service provided was medically necessary. If a claim doesn't demonstrate this need—whether due to poor documentation or the service not being covered under Medicaid's medical necessity guidelines—it can lead to a denial.

How long do you have to file a claim with NC Medicaid?

Medicaid claims, except inpatient claims and nursing facility claims, must be received by NCTracks within 365 days of the first date of service to be accepted for processing and payment. Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim.

For pdfFiller’s FAQs

What is Basic Medicaid and NC Health Choice Professional Claims?

Basic Medicaid is a state and federally funded program that provides health coverage to eligible low-income individuals and families in North Carolina. NC Health Choice is a program that offers health coverage to children in families with incomes too high to qualify for Medicaid but too low to afford private health insurance. Professional claims involve the billing for medical services rendered by healthcare providers under these programs.

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

Healthcare providers who deliver services to eligible Medicaid and NC Health Choice beneficiaries are required to file professional claims to receive payment for their services.

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

To fill out Basic Medicaid and NC Health Choice Professional Claims, providers must use the designated claim form, ensuring that all required fields are completed accurately, including patient information, provider details, dates of service, procedure codes, and diagnosis codes. Claims should be submitted electronically or via paper as per compliance guidelines.

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

The purpose of Basic Medicaid and NC Health Choice Professional Claims is to ensure that healthcare providers are reimbursed for the medical services they provide to eligible participants, thereby facilitating access to necessary healthcare services for low-income individuals and families.

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

The information that must be reported includes patient identification details, service provider information, procedure codes, diagnosis information, date of service, and the total amount billed. Additionally, supporting documentation may be necessary depending on the services rendered.