Healthy Opportunities Screening, Assessment and Referral Payment Claims Issue

Thursday, March 18, 2021

It has come to the attention of NC Medicaid that Edit 02088, which enforces a rule that coverage of procedure code G9919 for Healthy Opportunities Screening, Assessment and Referrals (HOSAR) positive screenings, be limited to providers affiliated with Carolina Access II (CAII) based on the rendering provider NPI. 

This rule has resulted in claims denials, as the necessary claims affiliation must be based on the billing provider NPI and not the rendering provider NPI, as originally required. NCTracks is working on resolving this issue with an anticipated release date of March 28, 2021. 

More information will be provided as available.


NCTracks Call Center, 800-688-6696