New Features for DME and Home Health Prior Approval-Updated

Note: This is an update to the previously published article. For Home Health, these features only apply to miscellaneous supply providers.

For Prior Approval (PA) requests for Durable Medical Equipment (DME) and Home Health miscellaneous supply services, a signed and completed certificate of medical necessity (CMN) is required. Currently in NCTracks, it is submitted using the paper Request for Prior Approval CMN/PA Form (DMA 372-131) available on the NCTracks website or by having the prescribing provider sign the system generated document when a PA request is submitted via the secure Provider Portal.

As of November 1, providers requesting DME and Home Health miscellaneous supply services can route through NCTracks a PA request to the recipient's (beneficiary's) prescribing provider for review. The prescribing provider can approve and electronically sign the request using their PIN, then submit to NCTracks for review. If the prescribing provider does not agree with the service request, the record can be returned back to the requesting provider to review and correct as applicable.

Per DMA policy, a prescribing provider is defined as a physician, physician assistant or nurse practitioner. A new NCTracks user role has been developed for this group to access the routed records - Prescribing Provider. The Office Administrator (OA) for the NPI must assign the appropriate authorized users this new user role in NCTracks to access records routed for review.

The paper CMN will remain available after November 1, but the online routing of the request can help expedite the submission of PA requests for providers.

Note: Home Health miscellaneous supply providers can only submit the form via NCTracks. They cannot mail or fax copies in. For home health providers, the CMN form is submitted as an attachment to the T1999 request submitted in the portal only if the provider does not intend to route the request for electronic signature in the system.

It is important to note that until a signed PA request is successfully submitted to NCTracks, it is not visible to the Call Center or the NC Division of Medical Assistance (DMA). Call Center Agents and DMA have no information to tell providers if they are calling about a record that is being routed between the requesting and prescribing providers. The two provider groups (prescribing provider and service provider) must communicate with each other if there are any questions on the status of one of these PA records.