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NC medicaid
lsw:
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?
PMRNC:
I think your S.O.L since their plan type is managed care and requires authorization. The patient could have sought PRIOR approval before the visit for an OON referral which may have been granted, but if it's after the fact, I think you are out of luck.
Pay_My_Claims:
--- Quote from: lsw on September 29, 2009, 05:06:21 PM ---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?
--- End quote ---
I'm confused by your post. I live in NC and bill NC medicaid. You said if they are NOT CA (carolina access) you have to use a CA participating psychiatrist or LME for a referral?? Why if they are straight Medicaid??
For outpatient behavioral health visits they must have a referal from their CA PCP. a LME or a MEDICAID enrolled psychiatrist prior to the first visit. If they are straight Medicaid then they would need a ref from a Medicaid enrolled psychiatrist.
http://www.ncdhhs.gov/dma/mp/8A.pdf
If I am misunderstanding something, please inform me.
PMRNC:
I'm a tad confused unless this provider pars with CA but not Medicaid...but it might still be Moot
--- Quote ---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.
--- End quote ---
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
rachel:
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!
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