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January 18, 2024

North Carolina Medicaid: Avoid claim denials

Claims that are missing required transition of care prior authorizations will be denied.

This serves as a reminder that all UnitedHealthcare Community Plan members require prior authorization approval for transition of care (TOC) from another Prepaid Health Plan (PHP). The PHP or the North Carolina Department of Health and Human Services (DHHS) must provide record of approval before the member receives services. 

Claims that are submitted without an approved prior authorization will be denied. 

What you need to do

If a member is receiving services without a TOC prior authorization, reach out to the case management team for retroactive approval using one of the methods below:

Email Call Fax

Email nchpcm@uhc.com and include a copy of the previously approved prior authorization with the following information: 

  • Member ID number
  • Provider information
  • Relevant codes
  • Care diagnosis

Call 855-873-2372 and provide them with the following information:

  • An explanation of the situation
  • Member ID number
  • Provider information
  • Any information from previously approved prior authorizations

Fax 855-541-8921 and include a copy of the previously approved prior authorization with the following information: 

  • Member ID number
  • Provider information
  • Relevant codes
  • Care diagnosis

Questions? We're here to help.

Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

PCA-1-23-04012-POE-NN_12212023

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