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*

ValueOptions® 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

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 ValueOptions® North Carolina Engagement Center has been an integral part of the mental health and substance abuse services delivery system in North Carolina since 1992.

ValueOptions 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, ValueOptions 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, ValueOptions 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 ProviderConnectSM. 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:

* These services require the Health Choice addendum be submitted with the ITR.
ˆ These services now require a CON be submitted as per the Medicaid guidelines.

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

Clinical Criteria – Intellectual and Developmental Disabilities (IDD)

  • Targeted Case Management (for IDD clients only)

http://www.ncdhhs.gov/dma/mp/8N.pdf
Click on the link, 'Clinical Coverage Policies for Medicaid Providers,' to access policy 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.)

ORF2 (Outpatient Review Forms)

Note: You have three options for completing the form.

Option 1: ProviderConnect (online submission)

Therapeutic Foster Care ProviderConnect Provider ID Request Form

Therapeutic Foster Care (TFC) requests can be submitted on ProviderConnect using any active Medicaid Provider Number used by the submitting provider. For example, an agency that also provides IIH may submit TFC requests via ProviderConnect with its IIH provider number. Submission of TFC requests with the provider number of another level of care is permissible because TFC authorizations are not made to the provider number of the request; rather TFC authorizations are made to LME associated to the recipient's county of eligibility. TFC providers are encouraged to record the confirmation number, print, and/or save down the request submission of the online TFC request as documentation of successful and timely submission of the request.

Therapeutic Foster Care providers that do not have a Medicaid Provider Number should use the form below to obtain an ID number to submit TFC requests online via ProviderConnect.

Provider Forms

Provider Forum

Provider Number Changes to Completed Authorizations

Upon request, ValueOptions 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 ValueOptions for the appropriate amount to:

ValueOptions, Inc.
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 to ValueOptions Customer Service at PSDCustomerService@valueoptions.com.

Deficit Reduction Act

Member Rights and Responsibilities

IMPORTANT!!

Effective January 1, 2013 there are significant changes to CPT codes for psychiatry and psychotherapy services. The CPT code set is defined by the American Medical Association (AMA) and describes procedures and services by physicians and other health care professionals. Providers serving North Carolina Medicaid and Health Choice must use the new code set when requesting prior authorization for 2013 dates of service; requests with terminated service codes beneficiaries will be returned as Unable to Process. Please refer to the monthly Medicaid bulletins available on the North Carolina Division of Medical Assistance website for additional information or contact DMA Behavioral Health at
919-855-4290.