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August 31, 2022NC HHS Tracks Companion Guide Benefit Enrollment and Maintenance (834O) ASC X12N005010X220A1This template is Copyright 2010 by The Workgroup for Electronic Data Interchange (WEI) and
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Medicaidncdhhsgovmedia6216nc DHHS of Health is a form used to report health information for Medicaid beneficiaries.
Healthcare providers and facilities that provide services to Medicaid beneficiaries are required to file medicaidncdhhsgovmedia6216nc DHHS of Health.
Medicaidncdhhsgovmedia6216nc DHHS of Health should be filled out with accurate and detailed information about the health services provided to Medicaid beneficiaries.
The purpose of medicaidncdhhsgovmedia6216nc DHHS of Health is to track and monitor the health services provided to Medicaid beneficiaries for billing and reporting purposes.
Information such as the type of healthcare service provided, dates of service, and billing information must be reported on medicaidncdhhsgovmedia6216nc DHHS of Health.
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