Provider Services

What’s New

HIPAA Companion Guides

The Health Insurance Portability and Accountability Act (HIPAA) requires the NC Department of Health and Human Services (DHHS) to adopt standards to support the electronic exchange of administrative and financial health care transactions between health care providers and plans. It mandates the standardization of Electronic Data Interchange (EDI) formats for health care data transmission, including claims, remittance, recipient eligibility, and claim status inquiries.

The ASC X12 HIPAA Implementation Guides define the national data standards, electronic format, and values for each data element within an electronic transaction. All providers, software contractors, billing services, value-added networks (VANs), and clearinghouses who submit claims electronically must adhere to the requirements outlined. Please refer to the HIPAA Companion Guides for additional information required to successfully exchange transactions. The companion guides are intended to supplement the HIPAA ASC X12 Implementation Guides. The information contained in the companion guides is not intended to be stand-alone.

Effective Date of Enrollment Packages (downloadable PDF documents)

In March 2011, we began adding a “watermark” to the top of each page whenever we modify an enrollment package. The watermark shows the effective date for the enrollment package’s changes. Once a package or form is updated, the North Carolina Division of Medical Assistance permits CSC to accept the outdated form version during a 60-day grace period. After 60 days, the prior version of an enrollment package cannot be accepted.

The effective date is applied to the entire enrollment package and may differ from the version date found at the bottom of an enrollment application or form. Applicants who use the interactive online Web application will not have to worry about the form effective dates; the Web version is always the latest official provider enrollment application.

Click on the link below to access a table that lists the current effective date and the previous effective date, if applicable, for each of the enrollment packages. The table also lets you know when the prior version of the package can no longer be accepted.

Enrollment Package Revision Matrix

Caller Verification

To comply with industry best practices, CSC’s EVC Operations Call Center Customer Service Agents (CSAs) are required to obtain specific information from callers, including the last four digits of the provider’s tax identification number (TIN), Social Security Number (SSN), or employer identification number (EIN) to confirm that the caller is the enrolled provider, provider applicant, or an authorized agent of the provider. If the caller cannot provide this required information, the CSA cannot discuss the provider file with the caller.

After greeting the caller, the CSA will ask for the provider’s Medicaid Provider Number or enrollment tracking number (ETN), the provider’s name, the physical site or accounting address, and the provider’s TIN, SSN, or EIN. The CSA will also ask for the caller’s name, the caller’s phone number, and the caller’s e-mail address before disclosing any information. Please have this information ready when you call so that CSC can assist you regarding provider enrollment.

If you have questions about this notice, please contact the CSC EVC Operations Center. CSAs are available Monday through Friday, 8:00 a.m. through 5:00 p.m. Eastern Time, at 1.866.844.1113.