North Carolina Health Choice

Important Numbers:

NC Health Choice Provider Services	1-800-753-3224
NC Health Choice FAX Numbers	NC Health Choice 1-877-339-8758*Beacon Health Options Automated Faxback Service (Telephonic Auth Letter Retrieval) 1-866-409-5958 * Please note that faxes sent to any other number will not be honored by NC Health Choice

NC Medicaid is Moving to Managed Care
For guidance on navigating this transition, including how to submit a Prior Authorization for members served under NC Medicaid Managed Care, please visit the NC DHHS provider resource page.

Note: Topics to the right do not apply to NC Health Choice for Children. All links for additional NC Health Choice information are identified below as you scroll down this page.

The Beacon Health Options North Carolina Engagement Center has been an integral part of the mental health and substance abuse services delivery system in North Carolina since 1992.

Beacon Health Options is a clinically focused company driven by the premise that delivering rather than denying care is the key to both optimal clinical outcomes and cost-effective care.

Since its inception, Beacon Health Options has provided utilization management services based on our belief that the most effective treatment is that which is appropriate to the needs of the person being served, easily accessible, provided by competent practitioners, and conducive to family involvement where possible. Treatment should be based upon best practices in the behavioral health care industry.

North Carolina Health Choice for Children

Since October 1998, Beacon Health Options has provided utilization review services for children in Health Choice.

Attention Health Choice Providers: You can now submit all of your requests for services via ProviderConnect^SM. Please be sure to complete ALL the fields whether they are required or not.

NC Health Choice Clinical Coverage Policies

For the following services you are required to complete and submit the ITR prior to the start of the service:

• Inpatient *^ http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
• PRTF *^ http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
• Partial Hospital Program http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
• Residential Services https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/behavioral-health-clinical-coverage-policies
• Enhanced Services https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/behavioral-health-clinical-coverage-policies

For the following services you are required to complete and submit the ORF2 (or include the Psychological Testing Request form):

• Outpatient Services and Psychological Testing http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
• Mobile Crisis http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
• Diagnostic Assessment http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies

Clinical Criteria – Intellectual and Developmental Disabilities (IDD)

• Targeted Case Management (Mental Health and Intellectual and Developmental Disabilities)

http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
Click on the link, Behavioral Health Clinical Coverage Policies to access policy 8L Mental Health/Substance Abuse Targeted Case Management and 8N for the Targeted Case Management for IDD, which is the only service available to Health Choice Children with Intellectual and Developmental Disabilities.

ITR (Inpatient Treatment Report)

Note: You have three options for completing the form.

Option 1: ProviderConnect (online submission)

• ProviderConnect Log In

(See NC Medicaid page under ‘Provider Training Opportunities’ section for ProviderConnect webinar trainings.)

 Option 2: ITR (May be completed on your PC)

• ITR Instructions
• ITR Form

Option 3: ITR (May be completed manually)

• ITR Instructions
• ITR Form

ORF2 (Outpatient Review Forms)

Note: You have two options for completing the form.

Option 1: ProviderConnect (online submission)

• ProviderConnect Log In

(See NC Medicaid page under ‘Provider Training Opportunities’ section for ProviderConnect webinar trainings.)

Option 2: ORF2 (May be completed on your PC)

• ORF2 Instructions
• ORF2 Form

Provider Forms

• North Carolina Health Choice Clinical Review Addendum
  (Submit for all services except Inpatient, PHP and services requested on ORF2)

• NC Health Choice Clinical Review Addendum (Print & Fax)
• NC Health Choice Clinical Review Addendum (PC Version)
• Psychological/Neurological Testing Request Form
• Child/Adolescent Discharge/Transition Plan – Residential Levels III or IV
• Certificate of Need (CON) Forms
  • Inpatient (General and Free Standing Hospitals)
    • Inpatient Certificate of Need (For Children Under 21)

    (Required for Free-Standing facilities only)

  • PRTF
    • PRTF Certificate of Need (For children Under 21)

Provider Forum

• Using ZixMail Encryption

Provider Number Changes to Completed Authorizations

Upon request, Beacon Health Options will change provider numbers on authorizations already in place. Such is typically related to an agency merger/acquisition or to correct a previous submission error. The fee is $9.70 for each authorization changed.
In order to request such changes, providers must complete the Provider Change Request Form located below and mail a hard copy of the completed form along with a check payable to Beacon Health Options for the appropriate amount to:

Beacon Health Options, Inc. NC PSD Clinical Director P.O. Box 13907 RTP, NC 27709-3907

The requested changes will be completed within ten business days after receipt of the check and completed form (extraordinary volumes may require longer). Providers may e-mail questions about this new service t Beacon Health Options Customer Service at PSDCustomerService@beaconhealthoptions.com

• Error/Merger Provider Change Request Form

Deficit Reduction Act

• Fraud and Abuse

Member Rights and Responsibilities

• Member Rights and Responsibilities