Effective Jan. 28, 2022, North Carolina Medicaid Division of Health Benefits required health care professionals to electronically attach sterilization consent forms and child medical evaluation forms when submitting claims.
The Claims tool on the UnitedHealthcare Provider Portal and electronic data interchange (EDI) submissions does not currently allow you to upload attachments with your claims. To comply with the state’s requirements, take these steps to electronically upload the forms:
Initial claim submission process
Within 5 calendar days
Submitting the required forms within the timeframe will generate the claims review process. If you miss the 5-day timeframe, the system will deny the claim and you’ll need to resubmit it.
The chart below shows the forms required for the procedures’ CPT® codes and which Smart Edit code will be triggered with your claim submission.
Procedure | CPT® codes | Form | Smart Edit code |
---|---|---|---|
Sterilization | 52500, 55250, 58600, 58605, 58611, 58615, 58661, 58670, 58671, 58700 | Sterilization Consent Form | uATCNCSC |
Child medical evaluation | 99499 | Checklist for Child Medical Evaluation (CME) Reporting | uATCCME |
Learn more
Take this online course for a visual guide on how to submit the Sterilization Consent Form and Child Medical Evaluation Form using Smart Edits. Learn more about Smart Edits at our UnitedHealthcare Resource Library.
CPT® is a registered trademark of the American Medical Association.