Timely Filing
For claims with a date of service on or after 7/1/2023, the Carolina Complete Health timely filing will be changing to 365 calendar days of covered service or discharge. For dates of service prior to 7/1/23, timely filing is 180 days. For more information, please see the NC DHHS Provider Playbook Prompt Payment Fact Sheet and the Carolina Complete Health Billing Manual
Lesser of Billed Charges Provisions
As of March 20, 2023, Carolina Complete Health was advised by NC DHHS to not apply lesser of billed charges to the following provider types: Durable Medical Equipment, the Physician Administered Drug Program rate floors, and Federally Qualified Health Centers and Rural Health Clinics. DHB is amending contract language in the summer amendment for lesser of billed charges provisions to specify the provider type exceptions.
Review the Billing Manual (PDF) for guidance.
Claim Type | First Claims Payment |
First Claims DOS |
Future Forward |
---|---|---|---|
Envolve Vision |
July 8, 2021 |
July 1 – 7, 2021 |
Weekly, Wednesday |
NIA |
July 13, 2021 |
July 1 – 9, 2021 |
Weekly, Tuesday and Friday |
Medical |
July 13, 2021 |
July 1 – 9, 2021 |
Weekly, Monday and Thursday |
Pharmacy |
July 14, 2021 |
July 1 – 7, 2021 |
Weekly, Wednesday |