Update for Claims Denied with EOB 00213

Behavioral health claims denied for EOB 00213 can be resubmitted with medical records (including the admit and discharge summary) for review by NCTracks medical staff for FINAL determination. The claims will no longer be reviewed by the State for an override.

Please follow the guidance provided in the EOB message:

NO PRIOR APPROVAL ON FILE. THE SERVICE OR SERVICE AND PRINCIPAL AND/OR ADMITTING DIAGNOSIS IS COVERED BY BEHAVIORAL HEALTH (BH) AND CLAIM SHOULD BE RESUBMITTED TO THE BH PLAN. IF BH WAS NOT THE REASON FOR THE VISIT, CHECK YOUR PRINCIPAL AND/OR ADMITTING DIAGNOSIS, CORRECT AND RESUBMIT. IF NO CLAIM UPDATES ARE NEEDED, RESUBMIT TO NCTRACKS WITH MEDICAL RECORDS FOR REVIEW.