Community Care of NC/Carolina ACCESS Overrides

This is an update to an article that was published on May 13, 2015. It contains additional information on requesting a CCNC/CA override and the features available.

Medical providers must obtain a Community Care of NC/Carolina ACCESS (CCNC/CA) Referral Authorization from the member's CCNC/CA Primary Care Physician (PCP) of record prior to rendering treatment, unless the specific service is exempt from CCNC/CA Referral Authorization. For a listing of exempt services, see "Section 6.4.4.3.2 Services Exempt from CCNC/CA Authorization" of the Provider Claims and Billing Assistance Guide at the link below.

NCTracks Provider Policies, Manuals, Guidelines and Forms page

When services are rendered to a CCNC/CA member without first obtaining a CCNC/CA Referral Authorization from the CCNC/CA PCP of record and the PCP refuses to authorize retroactively, medical providers may request an override. CCNC/CA overrides are authorizations issued by the NCTracks Customer Support Center for CCNC/CA members. CCNC/CA override confirmation numbers are not placed on the claim.

·  Override requests will only be considered if extenuating circumstances - beyond the control of the parties involved on the claim - affect the member's access to medical care.

·  Overrides will not be considered for current, future, or past dates of service unless the CCNC/CA PCP of record has been contacted and refused to authorize treatment.

·  Medical providers needing a CCNA/CA override must submit N.C. Division of Medical Assistance (DMA) CA Override Request to the NCTracks Customer Support Center.

·  All information needs to be legible and valid such as the NPI and Recipient ID being used.

·  Providers should provide a valid diagnosis or symptoms of why a CCNC/CA Override is being requested whether the request is by fax or phone.

·  Providers should only include the date of service within the current month on each type of request.

         - Phone requests cannot be processed with a past date of service whether in the current month or not.

         - Inpatient admission/ therapy services are an exception, they can be date spanned month to month.

·  Providers should include the requestor's name and number which is useful if there is a need for clarification.

The following are two preferred methods for submitting an Override Request:

·  Telephone - The provider can call NCTracks at 1-800-688-6696 to request an override for future dates of service, or if the member is in the provider's office waiting for treatment.

·  Fax - The provider can fax the Override Request Form to NCTracks at 1-855-710-1964. Providers may fax the override request form for past dates of service.

The form on NCTracks website has fillable form fields. This feature allows providers to print the completed form and save it to your device. A copy of the DMA CA Override Request Form can be found on the NCTracks "Provider Policies, Manuals, Guidelines and Forms" page. (See link above.) Be sure that the form is completely filled in as missing information can cause a delay in determining a status.

Providers may contact NCTracks at 1-800-688-6696 to check on the status of a pending override request.

Regional consultants are also available to assist providers with outstanding override requests. A current list of consultants is on DMA's CCNC/CA web page.