Community Care of NC/Carolina ACCESS Overrides

Medical providers must obtain a Community Care of NC/Carolina ACCESS (CCNC/CA) Referral Authorization from the member’s CCNC/CA Primary Care Physician (PCP) of record prior to rendering treatment, unless the specific service is exempt from CCNC/CA Referral Authorization.For a listing of exempt services, see “Section 6.4.4.3.2 Services Exempt from CCNC/CA Authorization� of the Provider Claims and Billing Assistance Guide at the link below.

NCTracks Provider Policies, Manuals, Guidelines and Forms page

When services are rendered to a CCNC/CA member without first obtaining a CCNC/CA Referral Authorization from the CCNC/CA PCP of record and the PCP refuses to authorize retroactively, medical providers may request an override. CCNC/CA overrides are authorizations issued by the NCTracks Customer Support Center for CCNC/CA members. CCNC/CA override confirmation numbers are not placed on the claim.

  • Override requests will only be considered if extenuating circumstances – beyond the control of the parties involved on the claim – affect the member’s access to medical care.
  • Overrides will not be considered for current, future, or past dates of service unless the CCNC/CA PCP of record has been contacted and refused to authorize treatment.
  • Medical providers needing a CCNA/CA override must submit N.C. Division of Medical Assistance (DMA) CA Override Request to the NCTracks Customer Support Center.

The following are two preferred methods for submitting an Override Request:

  • Telephone – The provider can call NCTracks at 1-800-688-6696 to request an override for future dates of service, or if the member is in the provider’s office waiting for treatment.
  • Fax – The provider can fax the Override Request Form to NCTracks at 1-855-710-1964. Providers may fax the override request form for past dates of service.

A copy of the DMA CA Override Request Form can be found on the NCTracks “Provider Policies, Manuals, Guidelines and Forms” page.  (See link above.)

 

Providers may contact NCTracks at 1-800-688-6696 to check on the status of a pending override request.

 

Regional consultants are also available to assist providers with outstanding override requests. A current list of consultants is on DMA’s CCNC/CA web page at www.ncdhhs.gov/dma/ca/mcc_051214.pdf.