Skip all navigation Skip to page navigation
NC Department of Health and Human Services
NC Division of
Medical Assistance

Claims and Billing

Determining the Right ICD-10 Codes

Providers can use the NCTracks ICD-10 Crosswalk and, after October 1, the DMA policies to determine the correct ICD-10 code. Neither the agents in the NCTracks Contact Center nor any DHHS employee can determine what the right diagnosis code is for any particular situation. Determining the correct diagnosis code can only be done by the medical professional treating the patient. 

Budget Initiatives

DMA will implement a number of changes in response to legislated budget reductions. Read more about budget initiatives > >

Submitting Claims to Medicaid

Annual Visit Limitation

Prior Approval

Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. Read more about prior approval > >

The Medicaid Recipient Due Process Rights and Prior Approval Policies and Procedures (PDF, 157 KB) documents the instructions for Medicaid recipient due process rights and prior approval procedures for N.C. Medicaid providers and all agency staff and contractors that perform utilization review functions on behalf of DMA.

Third-Party Insurance

Medicaid Management Information System (MMIS)

In December 2008, the N.C. Department of Health and Human Services awarded a contract to CSC to develop and implement a replacement Medicaid Management Information System (MMIS) in support of health care administration for multiple DHHS agencies, including DMA. Read more about the replacement MMIS > >

Electronic Health Record Incentives

The American Recovery and Reinvestment Act of 2009 External link provides for the promotion of electronic health records (EHR) through incentives. Read more about EHR > > Ready NC Connect NC