NCTracks Call Center Cannot Offer Policy-related Information

The NCTracks call center representatives cannot offer responses to any policy-related questions. Examples of policy-related questions are, “Is prior approval required for this service?” and “Is this CPT code covered by NC Medicaid?”

For information related to clinical coverage policy, providers should refer to the Medicaid Clinical Coverage Policy page on the NCTracks website.

Policies generally include:

  • Eligibility requirements
  • Special provisions
  • When the procedure, product or service is covered
  • When the procedure, product or service is not covered
  • Requirements for and limitations on coverage
  • Provider(s) eligible to bill for the procedure, product or service
  • Attachment A: Claims-related information

To locate all clinical coverage policies:

  1. Log on to https://medicaid.ncdhhs.gov/
  2. Click on the Providers tab located in the gray menu bar at the top of the page
  3. Click Provider Policies, Manuals, Guidelines and Forms from the menu bar on the left of the page
  4. Select Medicaid and NC Health Choice Clinical Coverage Policies
  5. Scroll to locate the appropriate policy