This bulletin replaces Updated Sterilization Consent Form published on Feb. 14, 2023, to update dates providers should be using each consent form.
The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated. It is available in English and Spanish.
Providers must access the Sterilization Consent Form on the Federal website. Providers may choose to complete the form for each individual or pre-populate information on the site prior to printing the consent form. Signature fields may not be pre-populated.
To limit permanent denials, providers must always use the latest version when submitting the sterilization consent form to the NC Medicaid fiscal agent.
Effective Feb. 16, 2023, providers must begin using the sterilization consent form with the end date July 31, 2025, when obtaining new consents.
- Claims submitted with the consent form with the end date April 2022 will continue to be accepted until Aug. 23, 2023, as signed consent forms are valid for 180 days.
- Backdating of consent form signatures is not acceptable and will also result in a permanent denial.
Contact
NCTracks Call Center: 800-688-6696