This document provides timely information related to known issues impacting providers. This will be updated weekly on Thursdays.
The North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services and the Department of Information Technology will be updating the IRIS system on May 25th. IRIS will be unavailable for all users beginning Wednesday, May 25th beginning at 7:00 a.m. and is expected to be available at 8:00 a.m. on Wednesday, May 25th.
Since IRIS reports are due within 72 clock hours from the time that the provider learns of an incident, providers may obtain a hard copy of the report from the IRIS website (https://iris.dhhs.state.nc.us/) before Wednesday morning or print forms from the DHHS website at https://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms. Reports can be submitted to Carolina Complete Health fax at 833-318-7255 and to DMH/DD/SAS Customer Service and Community Rights Team via fax at 919-733-4962 within specified timeframes and procedures. Providers will still need to enter the report into IRIS once the system is available. Reports to be filed with DHSR Healthcare Personnel Registry should be faxed to HCPR within specified timeframes at 919-733-3207. Reports regarding Deaths (suicide, homicide/violence, accident, or restraint) in a licensed facility should be reported to DHSR Complaint Intake Unit via fax at 919-715-7724.
Please be advised that codes 80050, 83718, 87633, 87636, 87637, 87798, & 87811 have been added to the Physician’s Office Lab Testing policy (NC.CC.PP.055) with an effective date of 04/19/2022. See the policy for the full list of codes specific to laboratory testing that are included for coverage in standard office settings.
Update from NC DHHS:
Medicaid postpartum health care coverage will be extended from 60 days to 12 months for eligible beneficiaries in North Carolina beginning April 1, 2022. The benefit will provide 12 months of continuous postpartum coverage to eligible beneficiaries who are currently pregnant or gave birth between Feb. 1, 2022, and March 31, 2022.
IMPORTANT: To get postpartum coverage for 12 months, the beneficiary’s caseworker at their local Department of Social Services (DSS) must be notified:
For more information, provider and beneficiary fact sheets, visit NC DHHS
Carolina Complete Health Quick Reference Guide Form (PDF)
Join the CCHN Provider Engagement team on a New Provider Orientation. For instructions on how to attend, please visit our education and training site.
New Provider Orientations will cover:
Registration is free and easy! Use the Log In button in the upper right hand corner of this webpage
Using the Secure Provider Portal (PDF), providers will be able to:
Claims may be submitted in 3 ways:
The timely filing deadline for initial claims is 180 calendar days from the Date of Service, or in the case of a health care provider facility, within one hundred eighty days after the date of the member’s discharge from the facility.
What is a paid claim?
Please visit the Claims and Billing section of our Provider Resources to view our billing manual.
Setting up EFT and ERA:
Carolina Complete Health offers Payspan, a free solution that helps Providers transition into electronic payments and automatic reconciliation. Payspan will be available 30 days before implementation
Access the Pre-Auth Check Tool to determine whether a prior authorization is required
Emergency services, family planning, post stabilization services, and table top x-rays do not require prior authorization.
Prior authorizations can be submitted in 3 ways:
For Prior Authorization Form, please visit our Manuals, Forms, and Guides page.
For Behavioral Health UM Prior Authorization Guidelines, please visit our Manuals, Forms, and Guides page.
Carolina Complete Health will use National Imaging Associates, Inc. (NIA) to provide the management and prior authorization of non-emergent, advanced, outpatient imaging services.
Please use the Help STAT! link on the upper right hand corner of this website to quickly be connected with the Carolina Complete Health Network team. This information is routed to an internal email address, managed during business hours.
You may also contact Network Relations by calling 1-833-552-3876 or emailing Networkrelations@cch-network.com
Advanced Medical Homes (AMHs), Hospitals, and Health Systems, are encouraged to reach out directly to their designated Provider Engagement Coordinator.