Get N.c. Dma: Revised Health Check Biling Guide 2010 - Ncdhhs

Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. Prior Approval and Due Process | NC Medicaid NC Medicaid (.gov) https://medicaid.ncdhhs.gov › programs-and-services NC Medicaid (.gov) https://medicaid.ncdhhs.gov › programs-and-services

An adult ages 19-64 may be eligible if the family income is $2,351/month or less. An adult ages 65+ may be eligible for full Medicaid if the family income is $1,704/month or less, and for other programs if the family income is $2,300/month or less. Additional requirements apply. NC Medicaid Eligibility ncdhhs.gov https://medicaid.ncdhhs.gov › eligibility ncdhhs.gov https://medicaid.ncdhhs.gov › eligibility

Modifier 50 Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5-digit code. Note: This modifier should not be appended to designated add-on codes.

All program-specific Clinical Coverage Policies can be found on the NCDHHS website.

Update your address and other information for Medicaid with an enhanced ePASS account – without having to call or visit your local Department of Social Services (DSS). Sign up today at epass.nc.gov. You can also visit or call your local DSS to check your information or report changes.

The NC Medicaid Drug Utilization Review (DUR) program for outpatient drugs ensures Medicaid recipients receive appropriate, medically necessary prescriptions that are unlikely to result in adverse medical events. NC DUR Board meetings are held quarterly.

Right to Appeal Specifically, due process means that when a Medicaid service request is denied, reduced, terminated, or suspended, you (or your personal representatives) must receive written notice of the adverse decision and have an opportunity for a fair hearing (appeal) pursuant to the Social Security Act, 42 C.F.R. Medicaid Recipient Due Process(Appeal Rights) lawhelpnc.org https://.lawhelpnc.org › resource › medicaid-recipie... lawhelpnc.org https://.lawhelpnc.org › resource › medicaid-recipie...