The North Carolina Department of Health and Human Services (DHHS) and prepaid health plans (PHPs) are committed to supporting providers during the transition to managed care. We stand by the Day One goal to ensure providers are paid for services they provide. DHHS and PHPs are aware of potentially delayed payments and increased claim denials during the transition period.
Providers experiencing claim payment issues should initially work with the PHPs to address claim issues and avoid the need for a hardship advance. Refer to the Guidance for Providers Experiencing Payment Issues bulletin for contact information.
As DHHS, PHPs and providers address the various claim processing problems, providers who are at risk of not meeting financial obligations this month as a result of claim processing issues may request a hardship advance to offset the business cost due to pended or denied claims. To request a hardship advance, send an email to the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. In the body of the email, include:
- Financial obligations the provider is unable to meet
- Estimated total monetary impact to the provider of unpaid managed care claims
- The NPI number of the provider who will receive the advance
- A list of the unpaid managed care claims, the associated PHP and the reason the claim has not paid (i.e. denial reason)
- Name, telephone number and email address of the provider’s contact person
DHHS and PHPs will respond to the completed request by contacting the provider to resolve any claim payment issues and sending a hardship agreement, if necessary. Upon resolution of the managed care claim transition issues, DHHS and PHPs will notify providers of the need to submit claims and if advances have been issued, they will be recouped from future payments.
Thank you for your patience and cooperation as we work to resolve managed care transition claim issues.