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NC Department of Health and Human Services
NC Division of
Medical Assistance

Third Party Insurance

Federal regulations require Medicaid to be the “payer of last resort.” This means that all third party insurance carriers, including Medicare and private health insurance carriers, must pay before Medicaid processes the claim. Additionally, providers must report any such payments from third parties on claims filed for Medicaid payment.

Third Party Insurance Codes

The spreadsheet list Third Party Insurance Codes.The system your case is in determines which list to use. If your case is currently in the EIS system, use the column called "EIS Code." For cases using the NCFast system, use the column titled NCFastCode. NOTE: NCFAST codes requires lead zeroes to make a six-digit number.

Health Insurance Premium Payments

The Health Insurance Premium Payment (HIPP) program is designed for Medicaid recipients with high-cost illnesses such as, chronic heart problems, end-stage renal disease, congenital birth defects, cancer, etc.

These recipients are often at risk of losing private health insurance coverage due to nonpayment of premiums. DMA will consider the benefit of paying health insurance premiums if it is found to be cost-effective.

More information on the HIPP Program > >

Third Party Insurance Forms

Contact DMA Third Party Recovery

Contact: Dionne M. Toney
Fax 919-814-0038
 Ready NC Connect NC