Attention: All Providers Carolina ACCESS Payment Authorization

Historically, the National Provider Identifier (NPI) of the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) Primary Care Provider (PCP) has been used in the Referring Provider field of a claim as payment authorization. Recently, it was indicated that providers would need to use the online managed care referral process; however, the guidance from the N.C. Division of Medical Assistance (DMA) has changed, as noted in the September Medicaid Special Bulletin.

Effective with date of service November 1, 2016:

• Providers will no longer put the NPI of the CCNC/CA PCP in the Referring Provider field of the claim
• Providers will not be required to use the online CCNC/CA referral process on the NCTracks provider portal
• CCNC/CA overrides will no longer be required

Claims for dates of service prior to November 1 will still require the NPI of the CCNC/CA PCP in the Referring Provider field of the claim or a CCNC/CA override must be obtained.

Providers are still expected to adhere to coordination of care practices associated with CCNC/CA.

If providers include the NPI of the CCNC/CA PCP in the Referring Provider field of the claim for dates of service after November 1, the claim will be subject to the edits associated with the OPR changes outlined in separate communication. Note: Some computer billing systems may automatically plug the PCP NPI on the claim.