Updated NCTracks Prior Approval Request Forms and Procedure for Retroactive NC Health Choice Requests

As of April 1, 2023, NC Health Choice was automatically moved to the Medicaid program. On April 21, 2024, NCTracks Prior Approval (PA) request forms will be updated to remove Health Choice as a payer option. The impacted PA forms are:

  1. Auditory Implant Sound Processor Request for Prior Approval (DMA-00003)
  2. Hearing Aids Services Request for Prior Approval (DMA-00001)
  3. Hospice Reporting (0004)
  4. Orthodontic Treatment Extension Request (DMA-0006)
  5. Orthodontic Treatment Termination Request (DMA-0007)
  6. Physician’s Request Form for Private Duty Nursing (3075)
  7. Request for Prior Approval CMN/PA (372-131)
  8. Visual Aid Request for Prior Approval (DMA372-017A)

Updated forms can be found on the Prior Approval page. For more information about the NC Health Choice move to NC Medicaid refer to the NC Health Choice Move to Medicaid Fact Sheet

Retroactive NC Health Choice requests must be submitted via the NCTracks Provider Portal. For more information about the PA request form submission via the Provider Portal, please refer to the available job aids listed in the Prior Approval section of the User Guides & Fact Sheets page.