The North Carolina Department of Health and Human Services (NCDHHS) and managed care health plans are committed to supporting providers to ensure they are paid for services they provide.
NCDHHS and health plans remind all providers of the hardship advance process available should they experience managed care claim payment issues that put them at risk of not meeting financial obligations.
Providers experiencing claim payment issues should initially work with the health plan to address claim issues and avoid the need for a hardship advance. Refer to the Health Plan Contacts and Resources page for health plan contact information.
As NCDHHS, health plans and providers address 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 claim payment issues.
Prior to submitting the hardship payment request, agencies must have submitted claims to the health plan for reimbursement. 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 as much of the following as possible:
- 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 health plan and the reason the claim has not paid (i.e. claim processing issue or denial reason). If a claim number has not been generated, for example due to electronic visit verification (EVV) processing issues, the Member ID and date of service can be provided instead of claim numbers.
- Name, telephone number and email address of the provider’s contact person
NCDHHS and health plans 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 claim processing issues, NCDHHS and health plans will recoup hardship advances from future payments.