North Carolina General Statutes Chapter 108C Medicaid and Health Choice Provider Requirements

• N.C. Gen. Stat. § 108C-1.   Scope; applicability of this Chapter
  This Chapter applies to providers enrolled in Medicaid or Health Choice. (2011-399, s. 1.)
• N.C. Gen. Stat. § 108C-2.   Definitions
  The following definitions apply in this Chapter: (1) Adverse determination. - A final decision by the Department to deny, terminate, suspend, reduce, or recoup...
• N.C. Gen. Stat. § 108C-3.   Medicaid and Health Choice provider screening
  (a) Provider Screening. - The Department shall conduct provider screening of Medicaid and Health Choice providers in accordance with applicable State or federal law...
• N.C. Gen. Stat. § 108C-4.   Criminal history record checks for certain providers
  (a) The Department shall conduct criminal history records checks of provider applicants and enrolled providers in accordance with federal law and regulation. (b) The...
• N.C. Gen. Stat. § 108C-5.   Payment suspension and audits utilizing extrapolation
  (a) The Department may suspend payments to a provider in accordance with the requirements and procedures set forth in 42 C.F.R. 455.23. (b) In...
• N.C. Gen. Stat. § 108C-5.1.   Post-payment review and recovery audit contracts
  The Department shall not pay contingent fees pursuant to any contract with an entity conducting Medicaid post-payment reviews or Recovery Audit Contractor (RAC) audits...
• N.C. Gen. Stat. § 108C-6.   Agents, clearinghouses, and alternate payees; registration required
  The Department is authorized to establish a registry of billing agents, clearinghouses, and/or alternate payees that submit claims on behalf of providers and to...
• N.C. Gen. Stat. § 108C-7.   Prepayment claims review
  (a) In order to ensure that claims presented by a provider for payment by the Department meet the requirements of federal and State laws...
• N.C. Gen. Stat. § 108C-8.   Threshold recovery amount
  The Department shall not pursue recovery of Medicaid or Health Choice overpayments owed to the State for any total amount less than one hundred...
• N.C. Gen. Stat. § 108C-9.   Provider enrollment criteria
  (a) Applicants who submit an initial application for enrollment in North Carolina Medicaid or North Carolina Health Choice shall be required to submit an...
• N.C. Gen. Stat. § 108C-10.   Change of ownership and successor liability
  (a) For providers subject to this Chapter, any of the following occurrences shall constitute a change of ownership: (1) In the case of a...
• N.C. Gen. Stat. § 108C-11.   Cooperation with investigations and audits
  (a) Providers shall cooperate with all announced and unannounced site visits, audits, investigations, post-payment reviews, or other program integrity activities conducted by the Department....
• N.C. Gen. Stat. § 108C-12.   Appeals by Medicaid providers and applicants
  (a) General Rule. - Notwithstanding any provision of State law or rules to the contrary, this section shall govern the process used by a...
• N.C. Gen. Stat. § 108C-13.   Certain waivers of Medicaid and Health Choice co-payments prohibited
  (a) No provider that has obtained a permit pursuant to G.S. 90-85.21 or G.S. 90-85-21A shall waive the collection of co-payments owed by recipients...
• N.C. Gen. Stat. § 108C-14.   Provider performance bonds
  (a) Subject to the provisions of this section, the Department may require Medicaid-enrolled providers to purchase a performance bond in an amount not to...

Last modified: March 23, 2014