Prior Approval Requirement for High Tech Imaging Terminating July 1, 2021
Effective for dates of service on or after July 1, 2021, prior approval (PA) for high tech imaging services (ultrasounds, computed tomography [CT], magnetic resonance [MRI] and positron emission tomography [PET]) will no longer be required for North Carolina Medicaid fee for service (Medicaid Direct) beneficiaries.
Beginning July 1, 2021, providers who contact eviCore will be notified that a beneficiary either does not require PA thorough Medicaid Direct or will be referred to the beneficiary’s prepaid health plan for assistance. PA is still required for high tech imaging services for delegated beneficiaries for dates of service prior to July 1, 2021. Retroactive eligibility will continue to be managed by eviCore.
NC Medicaid is in the process of end dating clinical coverage policy 1K-7, Prior Approval for Imaging Service that will be effective July 1, 2021.
To assist with this transition, NC Medicaid requests that imaging claims with dates of service prior to July 1, 2021, be submitted by Sept. 30, 2021.
NCTracks Call Center: 800-688-6696