Prior Approval Drugs and Criteria

Prior authorization is required for certain drugs prescribed to N.C. Medicaid and Health Choice recipients. Refer to the links below for specific criteria. Providers may submit requests for approval via fax, phone or the NCTracks secure prior authorization portal.

Behavioral Health Clinical Edits Criteria

 

BH Clinical Edit Resolution:  Submission Clarification Code 10

Bypassing the edit will require an override (SCC 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit.

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