Prior Approval FAQs

If you are seeking information about prior approval of Synagis, please go to www.documentforsafety.org.  CSRA does not process PA requests for Synagis and cannot provide information about the procedure or the status of a request. Forms faxed to CSRA requesting coverage of Synagis will not be processed. You may contact 'documentforsafety' provider support at 855-272-6576 for further assistance.

Prior Approval Status

1 - Pend AI 1 (Pend Alert 1):	This indicates that your PA request was incomplete. A letter was sent requesting additional information. If you have not already supplied the requested information, please be sure to include the Turn Around document that was provided with the letter. This Turn Around document has a bar code on the side, and will assist us with processing your PA faster. If this Turn Around document is not included, it could result in further delay.
A - Approved	This indicates that your PA request has been approved. A letter was sent regarding this approval.
D - Denied	This status indicates that your PA has been denied. A letter was sent with the reason for denial and appeal rights for the recipients.
M - ModApprov	This status means that a PA detail line is approved but not approved as submitted and that the units, amount or dates have been modified.
P - Pending	This status indicates your PA is still under review.
R - Reduction	This status indicates that your PA has been approved for units less than requested.
S - Suspended	This status indicates that your PA is new and being reviewed by a clinical specialist for a decision.
T - Terminated	This status indicates that your PA request was approved at one point. However, additional information was received that resulted in the termination of the PA with new effective and end dates.
V - Void	Void means that the request is either a duplicate of an existing request, the provider or recipient details on the request were incomplete, or the submitted procedure code is not on file. Void status means that the record is not available for matching on a submitted claim. A line on a PA may be voided if the code does not require PA.

 

You may still submit paper forms for PAs via mail or fax, however, it is strongly encouraged that you submit PAs electronically through NCTracks. Please note that if you submit PA requests online through NCTracks you save time and effort by not submitting paper forms. The electronic format also allows you to attach documentation, such as PDF files, instead of mailing them. NCTracks also allows for you to monitor the adjudication status of PA requests, including those not submitted to NCTracks.

 

If you choose to submit paper PA requests, you must use the NCTracks forms on the Prior Approval page. These forms have the NCTracks logo at the top of the forms. Legacy DHB PA forms are no longer accepted.

 

There are two exceptions to this policy. NCTracks is still accepting two antipsychotic forms:

• NORTH CAROLINA MEDICAID Off Label Antipsychotic Safety Monitoring In Recipients Less than Age 18 Years
• NORTH CAROLINA MEDICAID Adult Safety with Antipsychotic Prescribing.

 

Note: This does not affect prior approvals submitted to MedSolutions/eviCore, CCME, or other vendors.

 

If the medical doctor's signatures are dated beyond 30 days, then a new FL2 form is required. A doctor's signature is only valid for 30 days past the original date of signature.

Ideally, the supporting documentation should be uploaded and submitted with the FL2 request entered into NCTracks.  If you did not upload the supporting documentation at the time you entered the FL2 request, you can still do so by going back into the request on the portal.  This is the most expedient way to submit the supporting documentation.  Alternatively, you can fax or mail the supporting information within 10 business days to the address included on the PA Turn Around Document (cover sheet) you received upon completing your NCTracks FL2 PA request.

We do not receive FL2s via the phone. Providers can upload the FL2 form with the electronic FL2 prior approval request or they can complete the electronic FL2 portal submission and upload the Physician Signature form.

Providers may upload, mail or fax additional information or supplemental materials needed for a PA. Additional information and supplemental materials may include x-rays, dental molds, or CMN (Certificate of Medical Necessity) forms.

 

To upload: On the Attachment tab, click Upload and select the document type. You may upload up to 9 file attachments, or a file size up to 25MB.  This is the most expedient way of submitting additional information needed for a PA.

 

To mail or fax: Indicate that you are mailing or faxing additional information in the Attachments section on the Online PA form. For the Transmission code, select MAIL or FAX. Please note that once you submit the online PA form, a Turn Around Document will be generated via PDF. The Turn Around Document (PDF) should be included when mailing or faxing the additional information. The Turn Around Document (PDF) will ensure that the additional information is matched with the correct PA. If mailing, the mailing address is NCTracks, PO Box 31188, Raleigh NC 27622-1188. If faxing, the fax number for Pharmacy PA is  855-710-1969 and the fax number for Medical PA is 855-710-1964.
 

Yes

The system is designed to attach uploaded documents. Make sure you click the Add button (after uploading the attachment) before submitting the PA.

You would need to talk to the Hospital’s Discharge Planner to get a copy of the FL2.

Yes, if the hospital completing the form puts the receiving facilities’ NPI on the request, the Office Administrator for the receiving facility can see the FL2.

Technically, no, although it is recommended.

Yes

Because of HIPAA constraints.

No. Every call must go into the NCTracks Contact Center to be tracked.

Yes, if the recipient is not pending eligibility.

The system is designed to either allow units or price. Therefore for manually priced codes, staff cannot put in a unit. The approval letter should tell the number of units approved.

Only non preferred drugs are listed in the drop down box because preferred drugs do not require PA. Since Cardizem LA is a preferred agent, it would not be included in the drop down box. Diltiazem is a non preferred agent, therefore it is included in the drop down box.

That is correct. Only approval letters are sent to your Inbox. DHB only approved Approval letters to be sent via email. Law requires that Denial letters be sent certified mail because of the appeal rights. However, DHB is looking at allowing these letters to be put in the Inbox as well as mailing and/or making them viewable on the prior approval screen.