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 .0304 - CLAIMS REVIEW PROCEDURES

Universal Citation: 10A NC Admin Code 27A .0304

Current through Register Vol. 39, No. 6, September 16, 2024

(a) The LME shall review the claim to determine if it is clean. The determination shall be based on whether the claim is submitted as follows:

(1) the claim is submitted in one of the formats as set forth in Rule .0303 of this Section; and

(2) the information requested in each element of the selected format is complete.

(b) When a claim meets the requirements as set forth in Paragraph (a) of this Rule, it shall be considered a clean claim.

(c) The LME shall deny a claim that does not meet the requirements as set forth in Paragraph (a) of this Rule. The LME shall notify the provider of the denied claim. The notification shall specify the reason for denial and include the steps to be followed for resubmission.

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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