This bulletin is intended to clarify guidance previously shared on March 1st regarding a process change for inpatient authorizations. (Archived bulletin can be viewed online)
Providers should continue to request an authorization for elective inpatient services at least (14) days before the scheduled service delivery date. The only change to the provider is within the authorization number provided; it will begin with prefix "OP" (outpatient).
Upon the patient admitting for the inpatient stay following the procedure, please notify Carolina Complete Health within one business day in the same manner you do today. ADT feeds may also serve as notification of admission.
You do not have to request a second inpatient authorization for the stay. Once you notify the health plan of admission, the authorization already on file will transition into the IP authorization with a new auth number provided.
If you have questions regarding the information contained in this update, please contact your Provider Engagement Administrator. If you need your assigned Provider Engagement Administrator contact information, please visit: network.carolinacompletehealth.com/engagement
Medical necessity is defined for Carolina Complete Health beneficiaries as healthcare services, supplies or equipment provided by a licensed healthcare professional that are:
Experimental studies and related guidance is found in the following:
All medical services performed must be medically necessary and may not be experimental in nature. Experimental is defined as medical care that is investigatory or an unproven procedure or treatment regimen that does not meet generally accepted standards of medical practice in North Carolina.
In evaluating whether a particular service is or is not experimental the agency will consider safety, effectiveness and common acceptance as verified through:
Experimental studies and related guidance is found in the following:
Fax Number Reference Guide | |
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833-238-7690 | Carolina Complete Health Medicaid Face Sheets |
833-238-7691 | Carolina Complete Health Medicaid Assessments |
833-238-7692 | Carolina Complete Health Medicaid Inpatient Requests |
833-238-7693 | Carolina Complete Health Medicaid Medical Records |
833-238-7694 | Carolina Complete Health Medicaid Prior Authorization |
844-975-1325 | Carolina Complete Health Medicaid Census Reports |
833-596-2768 | Carolina Complete Health Inpatient Behavioral Health PA |
833-596-2769 | Carolina Complete Health Outpatient Behavioral Health PA |