NC Medicaid Managed Care medical claims submitted to a health plan have a timely filing claims processing deadline of 180 calendar days from the covered service or discharge.
As of July 1, 2021, medical claims processing timelines changed from one calendar year to 180 calendar days for managed care claims.
Health plans are responsible for claims processing and timely payments to providers for claims submitted within 180 calendar days of the date of covered service or discharge (whichever is later), except for pharmacy point of sale claims which shall be submitted within 365 calendar days of the date of the provision of care.
For more information regarding prompt payment standards, please see Medicaid bulletin Prepaid Health Plan Interest and Penalties for Provider Claims.
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