Document Tag: Manual

I. PURPOSE II. LEGAL RESPONSIBILITY AND REFERENCES III. NORTH CAROLINA GENERAL STATUTES IV. FRAUD VS. MISREPRESENTATION V. PREVENTION VI. DETECTION VII. INVESTIGATIONS VIII. CALCULATING OVERPAYMENTS IX. NORTH CAROLINA HEALTH CHOICE OVERPAYMENTS X. CONCLUSIONS AND RECOMMENDATIONS XI. NOTICES & APPEALS XII. ADMINISTRATIVE COLLECTION PROCEDURES XIII. BANKRUPTCY XIV. DISTRIBUTION OF CASH REPAYMENT XV. EPICS REPORTING REQUIREMENTS XVI.…

I. Introduction II. PROCEDURES

I. POLICY RULES II. PROCEDURES III. TYPES OF THIRD PARTY RESOURCES IV. INTERVIEW QUESTIONS FOR DETERMINING TYPES OF THIRD PARTY RESOURCES V. MEDICAID AS PAYER OF LAST RESORT OR AS PRIMARY PAYER VI. THIRD PARTY RECOVERY NON COMPLIANCE VII. THIRD PARTY INSURANCE FOR NCHC AND BCCM Additions/Terminations/Changes to Third Party Insurance Listserv (August 10, 2020)

I. INTRODUCTION II. BENEFIT VERIFICATION III. MANUAL VERIFICATION OF BENEFITS IV. THE SOLQ/TPQY SYSTEM V. DOCUMENTATION

I. INTRODUCTION II. WHO IS ENTITLED TO MEDICARE? III. POLICY PRINCIPLES IV. OVERVIEW OF MEDICARE COVERAGE V. OVERVIEW OF MEDICARE BUY-IN VI. EFFECTIVE DATE OF BUY-IN COVERAGE VII. RECIPIENT ENROLLMENT IN BUY-IN VIII. COUNTY RESPONSIBILITY TO ASSIST WITH MEDICARE APPLICATION IX. CHARGEBACKS FOR COUNTY ERRORS X. PROCEDURES FOR ALIENS XI. INFORMATIONAL MATERIALS SENT TO COUNTIES…

DHB ADMINISTRATIVE LETTER NO: 01-23, CHANGES IN INCOME DURING BASE PERIOD FOR MODIFIED ADJUSTED GROSS INCOME (MAGI) APPLICATIONS AND RECERTIFICATIONS DHB ADMINISTRATIVE LETTER NO: 04-23, MEDICAID PROCEDURES USING SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) INCOME DURING THE CONTINUOUS COVERAGE UNWINDING (CCU) PERIOD DHB ADMINISTRATIVE LETTER NO: 05-23, UNITED STATES POSTAL SERVICES (USPS) NATIONAL CHANGE OF ADDRESS…

I. POLICY RULES II. LENGTH OF CERTIFICATION PERIODS FOR CASES OTHER THAN MPW AND NEWBORN PROTECTION CASES (For MPW and newborn protection cases, see III., below.) III. LENGTH OF C.P.’S FOR MPW AND NEWBORN CASES IV. SPECIAL SITUATIONS V. PRE-NEED APPLICATIONS VI. REDETERMINATION/REVIEW VII. AUTHORIZATION DMA Administrative Letter NO:04-15, Certification Period

DHB ADMINISTRATIVE LETTER NO: 01-23, CHANGES IN INCOME DURING BASE PERIOD FOR MODIFIED ADJUSTED GROSS INCOME (MAGI) APPLICATIONS AND RECERTIFICATIONS DHB ADMINISTRATIVE LETTER NO: 02-23, MEDICAID PROCEDURES FOR COVID-19 – CHANGE TO DUALLY ELIGIBLE PROCEDURES DHB ADMINISTRATIVE LETTER NO: 03-22, HEARINGS AND APPEALS – REMOTE HEARINGS DHB ADMINISTRATIVE LETTER NO: 05-23, UNITED STATES POSTAL SERVICES…

I. INTRODUCTION II. TYPES OF EXEMPTIONS III. APPLICATION IV. RECERTIFICATION V. CHANGE IN SITUATION VI. BENEFICIARY COMPLAINTS AND INQUIRIES VII. PROVIDER INQUIRIES