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 In order to ensure that claims presented by a provider for payment by the North Carolina Department of Health and Human Services (NC DHHS) meet the requirements of federal and state laws and regulations and medical necessity criteria, a provider may be required to undergo prepayment claims review by NC DHHS. Grounds for being placed on prepayment claims review shall include, but shall not be limited to, receipt by NC DHHS of credible allegations of fraud, identification of aberrant billing practices as a result of investigations or data analysis performed by NC DHHS, or other grounds as defined by NC DHHS in rule.
Have a question for our prepayment claims review staff, email us at claimsreview@thecarolinascenter.org.
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