North Carolina Medicaid — NC Medicaid (Medicaid Managed Care Standard Plan)
| Program name | NC Medicaid (Medicaid Managed Care Standard Plan) |
|---|---|
| Provider portal | https://medicaid.ncdhhs.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the North Carolina Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in North Carolina
The Blue Cross Blue Shield Association licensee in North Carolina is Blue Cross and Blue Shield of North Carolina. This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in North Carolina
The dominant commercial insurers operating in North Carolina, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in North Carolina
NC Medicaid (Medicaid Managed Care Standard Plan) contracts with the following managed-care organizations to administer Medicaid benefits in North Carolina. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in North Carolina
Palmetto GBA is the Medicare A/B MAC for North Carolina: Part A and Part B fee-for-service claims from North Carolina go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 247 active LCDs from these contractors apply to North Carolina claims.
- Palmetto GBA
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- CGS Administrators, LLC
DME MAC (durable medical equipment and supplies)
Selected active Palmetto GBA policies for North Carolina
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35025 MolDX: Molecular Diagnostic Tests (MDT)
- L37379 Echocardiography
- L39671 Trigger Point Injections (TPI)
- L34415 CT of the Abdomen and Pelvis
- L39853 Outpatient Psychotherapy
- L35724 Urine Drug Testing
- L38779 MolDX: Minimal Residual Disease Testing for Cancer
- L39237 Erythropoiesis Stimulating Agents
- L33445 Removal of Benign and Malignant Skin Lesions
- L33459 Computerized Axial Tomography (CT), Thorax
- L38765 Facet Joint Interventions for Pain Management
- L37794 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
Equipment, home health and hospice policies that apply in North Carolina
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting North Carolina billing
- NC Session Law 2020-85 (surprise billing consumer protections, IDR)
- N.C. Gen. Stat. §58-3-225 (prompt pay — 30 days electronic clean claim)
- NC Medical Debt De-Weaponization Act (HB-1039, 2023 — hospital billing reform)
Provider licensing & enrollment in North Carolina
Providers enroll with NC Medicaid via NCTracks Provider Portal. Standard Plan PHPs use a centralized credentialing verification organization (CVO).
Major health systems headquartered in North Carolina
| Health system | Headquarters |
|---|---|
| Duke Health (Duke University Health System) | Durham, NC |
| Atrium Health (Advocate Health) | Charlotte, NC |
| Novant Health | Winston-Salem, NC |
| UNC Health | Chapel Hill, NC |
| WakeMed Health & Hospitals | Raleigh, NC |
Frequently asked questions — North Carolina billing
What is the North Carolina Medicaid program called?
North Carolina's Medicaid program is known as NC Medicaid (Medicaid Managed Care Standard Plan). Providers enroll and manage claims through the provider portal at https://medicaid.ncdhhs.gov.
What is the North Carolina Medicaid timely filing limit?
NC Medicaid (Medicaid Managed Care Standard Plan) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; North Carolina's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does North Carolina Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for NC Medicaid (Medicaid Managed Care Standard Plan). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in North Carolina?
The dominant commercial payers in North Carolina include UnitedHealthcare, Aetna, Cigna, Humana, along with the BCBS licensee Blue Cross and Blue Shield of North Carolina. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in North Carolina?
NC Medicaid (Medicaid Managed Care Standard Plan) contracts with 4 Medicaid MCOs tracked in the QuickIntell registry, including Centene, UnitedHealthcare, WellCare, Anthem (Elevance Health). MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in North Carolina?
North Carolina has 3 tracked state-level statutes that affect medical billing and RCM: NC Session Law 2020-85 (surprise billing consumer protections, IDR); N.C. Gen. Stat. §58-3-225 (prompt pay — 30 days electronic clean claim); NC Medical Debt De-Weaponization Act (HB-1039, 2023 — hospital billing reform). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in North Carolina with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to NC Medicaid (Medicaid Managed Care Standard Plan) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from North Carolina Medicaid and the member ID card before submission.