Prior Approvals for Out of State Services Changes
Effective Sept. 1, 2022, the adjudication of prior approvals (PA) for Out-of-State (OOS) Medical and Surgery services, Chimeric Antigen Receptor (CAR) T-Cell Therapy and Annual Legislative Visit Limit Overrides for NC Medicaid Direct beneficiaries will be performed by GDIT Fiscal Agent Operations Reviewers instead of clinical reviewers at NC Medicaid.
A physician will complete a final determination of OOS and CAR T-Cell Therapy PAs. The GDIT Fiscal Agent Operations Reviewers will complete and send approval/denial letters to the requesting in-state providers after each review.
The basic process of submitting a PA for OOS services, CAR T-Cell Therapy and Annual Legislative Visit Limit Overrides will remain the same, other than GDIT will be reviewing the requests and communicating the results.
Providers can email email@example.com with any questions or issues with OOS services.
- Documentation for PA requests may be faxed to 855-710-1964.
- For GDIT customer service, please call 800-688-6696.
NCTracks Call Center: 800-688-6696