Update to Appeal Language in North Carolina Medicaid Provider Adverse Action Letters

North Carolina Medicaid, in collaboration with General Dynamics Information Technology (GDIT), has updated the appeal content used in certain state-initiated NC Medicaid provider adverse action letters generated through the NCTracks system. These updates aim to ensure clarity and consistency in how appeal rights are presented to providers.

What’s Changing

The appeal language has been revised in the following types of provider letters to allow additional time to request a reconsideration, and to update the contact information for the NCDHHS Hearing Office and Office of Administrative Hearings (OAH):

  • Provider Termination Letters
  • Involuntary Carolina Access (CA) Termination Letters
  • Application Denial Letters
  • Application Denial for Specific Locations Letters
  • Taxonomy Denied Letters

These changes do not apply to voluntary terminations or other provider-initiated actions where appeal rights are not applicable.

Providers who receive one of the above letters will see the updated appeals language below:

 

Updated Appeal Language:

If you wish a reconsideration of this decision, please submit a request by mail, email or fax within 30 business days of the date of this letter to:

Chief Hearing Officer

NCDHHS Hearing Office

2501 Mail Service Center

Raleigh, North Carolina, 27699-2501

Phone: 1-919-814-0090

EMAIL: Medicaid.hearings@dhhs.nc.gov

FAX:919-882-1179

You may request a telephone or in-person hearing. You may also submit written documentation for review. The documentation must be received within 30 business days from the date of this letter in order to be considered. If you request an in-person hearing, the hearing will be scheduled at the NCDHHS Hearing Office in Raleigh, North Carolina. Following reconsideration review, you will be notified in writing of the decision.

If you do not request a Reconsideration Review or if you disagree with the reconsideration review decision, you may file a petition for a contested case hearing with the Office of Administrative Hearings (OAH) in accordance with G.S. § 150B-23(a). You have 60 calendar days from the date of this letter or the date of the reconsideration review decision to file a contested case petition with the OAH. Petition forms are available on the OAH website at https://www.oah.nc.gov/hearings-division/filing/hearing-forms. There may be a fee associated with filing a petition at OAH. If you have questions about the OAH appeal process or the filing fee, OAH can be reached directly at 984-236-1850. Please be advised that if you do not file a petition within sixty (60) days of either the date of this letter or the reconsideration review decision, you can lose your right to appeal.

You must file the contested case petition form with the Office of Administrative Hearings, either in person at 1711 New Hope Church Road, Raleigh, NC 27609, by mail at 6714 Mail Service Center, Raleigh, NC 27699-6700, by fax during normal business hours by faxing the petition to the Clerk’s Office at 1-984- 236-1871, or by electronic transmission in accordance with 26 NCAC 03.0101(b). 

 Electronic mail without an attached file shall not constitute a valid filing. In addition, you must mail a copy of the petition to NC Department of Health and Human Services, Julie Cronin, General Counsel, Office of Legal Affairs, Adams Building, 2001 Mail Service Center, Raleigh, NC 27699-2001 (https://ncdoj.gov/legal-services/legal-resources/process-agent-directory/). 

Questions? If you have questions regarding this notice or need additional assistance, please contact the NCTracks Operations Center at 1-800-688-6696, or email the NCTracks Operations Center at NCTracksprovider@nctracks.com.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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