Discontinuation of Medical/Surgical PA form DMA 372-118

Effective December 18, 2016, NCTracks will no longer accept Prior Approval (PA) form DMA 372-118 requests by fax or mail for:

• Medical
• Surgical
• Out –of-state medical
• Out-of-state surgical
• Out-of-state ambulance services
• Transplants

In addition, NCTracks will no longer accept requests for exceptions to the legislative visit limit by fax or mail.

These requests can only be submitted on the NCTracks secure provider portal. No submissions will be accepted via fax or mail using a paper form. (The form will be removed from the NCTracks Prior Approval web page.)

Providers who continue to fax or mail these forms will be sent a rejection letter stating the form is no longer accepted.

For further information on the online submission of PA requests, refer to the Computer Based Training (CBT) and Instructor Led Training (ILT) Participant User Guides on Prior Approval available in SkillPort on the NCTracks secure provider portal.

Providers who do not have an NCID to access the NCTracks secure provider portal should contact the Office Administrator for their NPI.