Guidance for Providers Experiencing Payment Issues Actions providers should take to reduce claim denials and payment delays
During the transition period after NC Medicaid Managed Care launch, providers may experience payment issues from an increase in claim denials. Providers should take the following actions to reduce claim denials and payment delays:
- Submit claims to the correct payer as described in the Managed Care Claims and Prior Authorizations Submission: What Providers Need to Know – Part 1 Fact Sheet
- Follow PHP claim submission and billing guides referenced in the Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions – Part 2 Fact Sheet
- When a claim gets denied, review the denial reason, the information on the claim, the health plan guidance documents and the Medicaid and NC Health Choice clinical coverage policies to identify and correct provider billing errors
- Contact the health plan using the Day One Provider Quick Reference Guide for claim questions
If a provider is unable to resolve claim payment issues through that process, they should follow the guidance below to contact the health plan.
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Health Plan |
PHP Guidance for Payment Issues |
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AmeriHealth Caritas (AMHC) |
Providers are encouraged to call Provider Services at 888-738-0004 or to contact their dedicated Account Executive with any issues or concerns. Providers may find the contact information for their dedicated Account Executive by downloading the PDF version of our network map available at https://www.amerihealthcaritasnc.com/assets/pdf/provider/acnc-account-executives-by-region.pdf |
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Carolina Complete Health (CCH) |
Questions for financial concerns may be sent to: CCHNfundingrequest@cch-network.com |
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Healthy Blue |
If a provider has questions about their claims submission or believes their claim has taken longer to process than the timelines outlined in the Healthy Blue Provider Manual, please contact the Healthy Blue Provider Relations team at 844-594-5072 or nc_provider@healthybluenc.com |
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United Healthcare (UNHC) |
Your Provider Relations team is an important resource when you have questions. They are your single point of contact across all lines of business and benefit plans to help make your interactions with us easier and more efficient.
Provider Services Contacts
Contracting Contacts Sometimes, claims issues may result from contracting or participation issues. If you have questions about your network participation status, please contact our Network Contracting team. Be sure to include a description of your issue or question. |
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WellCare (WCHP) |
Send payment issue inquiries to ncproviderrelations@wellcare.com |
If a provider continues to have unresolved payment issues, they should contact the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or 866-304-7062.
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