North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 27 - MENTAL HEALTH, COMMUNITY FACILITIES AND SERVICES
Subchapter A - FISCAL RULES
Section .0300 - CLEAN CLAIMS
Section 27A .0303 - CLEAN CLAIM FORMAT REQUIREMENTS
Universal Citation: 10A NC Admin Code 27A .0303
Current through Register Vol. 39, No. 6, September 16, 2024
(a) A provider of a service that is payable from funds administered by an LME shall submit a claim for payment to the authorizing LME. The provider shall submit the claim in one of the formats listed as follows:
(1) HIPAA compliant 837;
(2) CMS-1500;
(3) the standardized billing format provided
by the DMH/DD/SAS; or
(4) a single
web based direct data entry system.
The provider shall complete each element contained in the selected format.
(b) The billing format provided by the DMH/DD/SAS shall contain standardized elements including:
(1) date of claim;
(2) provider information including:
(A) name; and
(B) number.
(3) client information including:
(A) name;
(B) identification number;
(C) target population code; and
(D) ICD-9 diagnosis code.
(4) service information including:
(A) name;
(B) date;
(C) units delivered;
(D) billing code; and
(E) authorization number.
Authority
G.S.
122C-112.1(a)(32); S.L.
2006-142;
Eff. May 1, 2008;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. June 25,
2016.
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