In preparation for Managed Care Launch on 07/01/2021, UHC Community Plan of North Carolina will comply with the prompt payment requirements as defined in the PHP contract. Those requirements mandate processing payments within 14 calendar days for pharmacy claims and 30 calendar days for medical claims.
Please note the following timeline the first check cycles will begin:
For additional inquiries, please contact Provider Services at 800-638-3302.
If you aren’t satisfied with the outcome of a claim reconsideration request, you may submit a formal claim dispute/appeal using the process outlined in your Care Provider Manual.
Please allow 10 business days from the submission date before requesting a status update to enable us to begin processing the review.
Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. We encourage you to use the following tools and resources to get started with electronic transactions.
If you are an Out-of-State Provider, you MUST be contracted with NC Medicaid through the NC Tracks system in order for claims to be paid.
A PRA is generated for every processed claim and includes relevant details about how the claim was processed.