10A N.C. Admin. Code 27A.0303

Current through Register Vol. 39, No. 9, November 1, 2024

Section 27A .0303 - CLEAN CLAIM FORMAT REQUIREMENTS

(a) A provider of a service that is payable from funds administered by an LME shall submit a claim for payment to the authorizing LME. The provider shall submit the claim in one of the formats listed as follows:

(1) HIPAA compliant 837;

(2) CMS-1500;

(3) the standardized billing format provided by the DMH/DD/SAS; or

(4) a single web based direct data entry system.

The provider shall complete each element contained in the selected format.

(b) The billing format provided by the DMH/DD/SAS shall contain standardized elements including:

(1) date of claim;

(2) provider information including:

(A) name; and

(B) number.

(3) client information including:

(A) name;

(B) identification number;

(C) target population code; and

(D) ICD-9 diagnosis code.

(4) service information including:

(A) name;

(B) date;

(C) units delivered;

(D) billing code; and

(E) authorization number.

10A N.C. Admin. Code 27A .0303

Authority G.S. 122C-112.1(a)(32); S.L. 2006-142;
Eff. May 1, 2008;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.

Authority G.S. 122C-112.1(a)(32); S.L. 2006-142;
Eff. May 1, 2008.