Issued: March 22, 2023

Claims Information Related to NC Medicaid Direct Launch on April 1

Effective April 1, 2023, Partners Medicaid benefit plan will transition to NC Medicaid Direct. Partners is providing information on submitting professional and institutional claims.

What is happening?

Partners is clarifying how providers should submit professional and institutional claims on or before April 1, 2023.

This impacts claims types CMS1500 (professional claims) and UB04 (institutional codes). 

When is this happening?

April 1, 2023.

What must providers do?

Professional claims (CMS1500): Providers must make sure claims are not submitted with the dates of service that cross over benefit plans for Medicaid and NC Medicaid Direct. Claims with dates of service on or before March 31, 2023, should be submitted on a separate claim than claims with dates of service beginning on April 1, 2023.

Institutional claims (UB04): Claims will be processed by the benefit plan the member has on the date of admission. (Example: A member is admitted on March 30, 2023 and is discharged on April 3, 2023. Partners would process the claim against the current Medicaid benefit plan and not the NC Medicaid Direct benefit plan which begins April 1, 2023).

What if providers have questions? 

Please email or call 704-842-6486 with any questions.