North Carolina Payer Configuration and Requirements Tables
The payer configuration table is a valuable resource to help you understand the specific requirements for each payer contract as they relate to the integration process. By referencing this table, you can ensure the correct configuration of payer contracts, maintain compliance, and streamline workflows. Use this topic as a quick reference to verify the scope of each payer’s requirements and to facilitate a smooth integration process.
Alliance Health HHCS
| Payer Configurations and Requirements | Alliance Health HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1,056,000 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
AmeriHealth Caritas of North Carolina HHCS
| Payer Configurations and Requirements | AmeriHealth Caritas of North Carolina HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1320 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Carolina Complete Health HHCS
| Payer Configurations and Requirements | Carolina Complete Health HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1320 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Partners NC PROD HHCS
| Payer Configurations and Requirements | Partners NC PROD HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1,056,000 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Trillium Health Resources HHCS
| Payer Configurations and Requirements | Trillium Health Resources HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1,056,000 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
UnitedHealthcare Community Plan of NC HHCS
| Payer Configurations and Requirements | UnitedHealthcare Community Plan of NC HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1320 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Payer Managed |
| Referring Physician Required | Not in Scope |
WellCare of North Carolina LTSS HHCS
| Payer Configurations and Requirements | WellCare of North Carolina LTSS HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1320 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Vaya NC HHCS
| Payer Configurations and Requirements | Vaya NC HHCS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Soft Go-Live |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 1,056,000 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |