Claim Issue for Outpatient Specialized Therapy Services

NCTracks is aware of a claim issue for Outpatient Specialized Therapy services. Providers are receiving EOB 01807- OUTPATIENT SPECIALIZED THERAPY SERVICES REQUIRE PRIOR AUTHORIZATION. In these cases, the benefit health plan on the prior authorization for the recipient is incorrect; the benefit health plan is different than the NCTracks eligibility information causing the claim to deny. Providers will need to contact The Carolinas Center for Medical Excellence (CCME) at 1-800-228-3365 to request prior approval going forward under the correct benefit health plan.

(This is an update to the May 12 announcement.)