Hi, I have a questions that concerns billing for a LPC to NC medicaid. If the patient is Carolina Access you use the referring CA PCP for the referring doctor but if the patient is not CA, just straight medicaid, you have to use a CA participating psychiatrist or LME for a referral These charges were incurred without getting a referral. There is not a CA participating psychiatrist in Western NC to use and the LME will not do a retroactive referal. Is there any way to get these claims paid?
but if the patient is not CA, just straight medicaid, you have to use a CA participating psychiatrist or LME for a referral These charges were incurred without getting a referral.
I'm a tad confused unless this provider pars with CA but not Medicaid...but it might still be Moot Quotebut if the patient is not CA, just straight medicaid, you have to use a CA participating psychiatrist or LME for a referral These charges were incurred without getting a referral.In most states Medicaid requires pre-authorization, if there are NO other Medicaid providers in a given area they may give a pre-approval but it has to be done BEFORE the visit as they won't give retro referals/Auths
I am not sure if your situation would qualify but I was advised that there is a way to override and get a claim submitted. You go to the DMA website under Providers, then to Community Care of NC, in the list is the CA Override Request, fill out and fax. I personally have not utilized this form so I have no other info to provide...sorry...good luck...Let me know how it works out! Hope this helps!