Escalation Process for Standard Plan Provider Claims Payment Issues

This bulletin applies to Standard Plans. 

Providers are encouraged to contact health plans directly to address any discrepancies in claim payment issues. Providers should use their respective health plan’s call center, provider relations teams and appeal/grievance processes to resolve any outstanding claims issues.

If claims payment issues arise with Standard Plans and are escalated to the Provider Ombudsman, providers must have the required information below before the NC Medicaid will intervene: 

1. Health Plan Reference Number/email or communication  
2. Number of claims impacted
3. Dollar amount for the impacted claims  
4. Claim numbers (Provide examples if it there a large volume of claims)  
5. NPI number  
6. Provider’s expected resolution  

Standard Plan Claim Payment Issue Contact Information

Standard Plan Provider Grievance and Appeal Process

Contact

Medicaid.ProviderOmbudsman@dhhs.nc.gov