Payment Issues

DHHS and PHPs are aware of potentially delayed payments and increased claim denials during the transition period. Providers experiencing claim payment issues should initially work with the PHPs to address claim issues and avoid the need for a hardship advance. 

For more information refer to the Guidance for Providers Experiencing Payment Issues bulletin [medicaid.ncdhhs.gov] & Claims Denied – Taxonomy Codes Missing, Incorrect, or Inactive.

Hardship Advances

As DHHS, PHPs and providers address the various claim processing problems, providers who are at risk of not meeting financial obligations this month as a result of claim processing issues may request a hardship advance to offset the business cost due to pended or denied claims.  

To request a hardship advance, send an email to the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. In the body of the email, include: 

• Financial obligations the provider is unable to meet 
• Estimated total monetary impact to the provider of unpaid managed care claims 
• The NPI number of the provider who will receive the advance 
• A list of the unpaid managed care claims, the associated PHP and the reason the claim has not paid (i.e. denial reason) 
• Name, telephone number and email address of the provider’s contact person 

DHHS and PHPs will respond to the completed request by contacting the provider to resolve any claim payment issues and sending a hardship agreement, if necessary. Upon resolution of the managed care claim transition issues, DHHS and PHPs will notify providers of the need to submit claims and if advances have been issued, they will be recouped from future payments.  

Thank you for your patience and cooperation as we work to resolve managed care transition claim issues. 

For more information, please see the Medicaid bulletin Expedited Hardship Advances for Managed Care Providers [medicaid.ncdhhs.gov].

NC DHHS now offers NC residents access to view and/or print their vaccination cards via the NC Covid-19 Vaccine Portal. The NC COVID-19 Vaccine Portal is a free, fast and secure way for many North Carolinians to present proof of COVID-19 vaccination or print a copy of your COVID-19 vaccine information for other purposes.  

Visit this link for more information: https://covid19.ncdhhs.gov/vaccines/after-youve-been-vaccinated/your-vaccine-information 

• $17 billion for Provider Relief Fund (PRF) Phase 4 payments for a broad range of providers who can document revenue loss and expenses associated with the pandemic. For these Phase 4 payments, smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—will receive reimbursements for lost revenues and COVID-19 expenses at a higher rate compared to larger providers. Phase 4 will also include bonus payments based on the amount of services providers furnish to Medicaid/Children’s Health Insurance Program (CHIP) and Medicare patients, who tend to be lower income and have greater and more complex medical needs.
• $8.5 billion from the American Rescue Plan (ARP) for providers who serve rural Medicaid, CHIP, or Medicare patients. ARP Rural payments to providers will be based on the amount of Medicaid/CHIP and Medicare services provided to patients living in rural areas as defined by the Federal Office of Rural Health Policy.

• Additional Dose Information
• Monoclonal Antibodies Therapy FAQ
• Parental Consent for COVID-19 Vaccines Under Emergency Use
• Vaccine Hesitancy Resources
  • Facilitating Vaccination in Your Practice (English)
  • Facilitating Vaccination in Your Practice (Spanish), Part 1 & Part 2

• September Newsletter
• Monday Corner: Medicaid Managed Care and COVID-19 (8/23)
• Monday Corner: Medicaid Managed Care and COVID-19 (8/9)