April 19, 2022

North Carolina: Submit required sterilization consent and child medical evaluation forms for claims using Smart Edits

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

  • Submit your claim electronically using the Claims tool or EDI. You will not be able to upload your forms at this time.
  • You’ll receive a Smart Edit message within 24 hours indicating the form is missing and must be submitted

Within 5 calendar days

  • Open Trackit in the UnitedHealthcare Provider Portal
  • Go to and select Sign In in the upper-right corner
  • Sign in to the portal with your One Healthcare ID and password
  • Once in the portal, go to the upper-right corner and select Trackit next to your account icon
  • Click on Smart Edit and identify the claim(s) that shows the Smart Edit code (see chart below)
  • Click on the Action Required button and upload the form into the tool

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.