D. Providers

GUIDANCE DOCUMENTS FORMS AND TEMPLATES
Hospital Payments for Behavioral Health Claims (Feb. 4, 2019 | v1.0) PHP Network File Layout (June 5, 2019 | v1.3)
North Carolina Medicaid Managed Care Network Adequacy Standards (March 14, 2019 | v1.0) PRV001-J Network Adequacy Exceptions Report (Jan. 30, 2019 | v1.0)
Process to Notify PHP of Provider Termination (Feb. 4, 2019 | v1.0) PRV002-J Essential Provider Alternate Arrangements Report (Jan. 30, 2019 | v1.0)
Process to Notify PHP to Reinstate Provider Payments (Feb. 4, 2019 | v1.0) PRV003-J Provider Contracting Determinations and Activities Report (Jan. 30, 2019 | v1.0)
Process to Notify PHP to Suspend Provider Payments (Feb. 4, 2019 | v1.0) PRV004-J Network Data Details Report (Jan. 30, 2019 | v1.0)
  PRV005-J Provider Network Geographical Mapping Report (March 11, 2019 | v1.0)
  PRV006-J Timely Access Physical Health Provider Appointment Wait Times Report (Jan. 30, 2019 | v1.0)
  PRV007-J Timely Access Behavioral Health Provider Appointment Wait Times (Jan. 30, 2019 | v1.0)
  PRV008-J Network Access Report (Jan. 30, 2019 | v1.0)
  PRV009-J Provider Preventable Conditions Log (Jan. 30, 2019 | v1.0)
  PRV011-J Provider Grievances and Appeals Report (Jan. 30, 2019 | v1.0)
  PRV012-J Litigated Provider Appeals Report (Jan. 30, 2019 | v1.0)
  PRV013-J NCMT Local Health Department Directed Payment Invoice Template (Jan. 30, 2019 | v1.0)
  PRV013-J NCMT Public Ambulance Provider Directed Payment Invoice Template (Jan. 30, 2019 | v1.0)
  PRV013-J NCMT Summary Remittance Advice Report Template (Jan. 30, 2019 | v1.0)
  PRV014-J Provider Quality Assurance Report (Jan. 30, 2019 | v1.0)
  PRV015-J Out-of-Network Service Requests Report (Jan. 30, 2019 | v1.0)
  PRV016-J Network Exceptions Narrative (Jan. 30, 2019 | v1.0)
  PRV017-J Alternative Arrangements Narrative (Jan. 30, 2019 | v1.0)
  Request for Alternative Arrangement for an Essential Provider (March 13, 2019 | v2.0)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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