Update on Validation of PA Requests Submitted via NCTracks Portal

On October 29, 2017, the NC Department of Health and Human Services (DHHS) added four new data validations during the entry of prior approval (PA) requests through the NCTracks secure provider portal. Specifically:

• The requesting provider must be an in-state/border provider
• All providers on the PA record must have an active status in NCTracks by the requested PA begin date on each detail line
• All providers on the PA record must be actively enrolled in the health plan selected for the PA as of the requested PA begin date on each detail line
• The recipient must be actively enrolled in the health plan selected for the PA by the requested PA begin date on each detail line

These data validations were previously performed after the PA was submitted in NCTracks, which resulted in the denial or void of a PA record. As of October 29, if a validation fails during PA entry, the user will not be able to submit the record until the data are corrected.

Note: For hospice and long term care, if a PA request is submitted for a recipient with pending eligibility, the recipient health plan validation is bypassed.

Other exceptions to the new validations include Orthodontic and Dental PA requests. The in-state/border provider requirement does not apply to Pharmacy, Durable Medical Equipment, out-of-state ambulance or auditory implant PA requests.

For more information on the submission of PA requests, refer to the Prior Approval page of the NCTracks provider portal, as well as the Provider User Guides and Training page and the Provider Training catalog in SkillPort on the secure provider portal.