New NC Provider 2057 Insurance Referral Form Feature

On Aug. 1, 2016, HMS added options to the NC Provider 2057 Insurance Referral form, which is used by providers to update a beneficiary’s insurance policy information. The online form is the most efficient and timely way to update a beneficiary’s insurance information on NCTracks. Within three days of the form’s submission, HMS will review it, verify policy information and update the beneficiary’s policy information on NCTracks.

Criteria used to verify and update the policy information are:

  • Medicaid identification number
  • Social Security number
  • Policy begin and end date
  • Group number
  • Insured first and last name
  • Employers name and address

The new form also provides specific options for the reason of the referral, which are:

  • The beneficiary’s Medicaid eligibility file does not list the policy above
  • Beneficiary has never been covered by the policy
  • Beneficiary’s coverage ended (date)
  • Policy lapsed (date)
  • Carrier has changed; new carrier is _________
  • Other

Note: Providers who fail to add all of the required information with their submission will have their request denied. Required fields are marked with an asterisk [on the form].

To access the new form, click on the following link https://ncprovider.hms.com/.

Those with questions should contact HMS at 866-263-2227 option No. 4. (The HMS website currently says option No. 6, but option No. 4 is correct.)