10A NCAC 25H .0206. PRIOR APPROVAL

(a)  All required prior approval shall be by the private contractor mentioned in 10A NCAC 22A .0101, and shall be given on the basis of medical need.

(b)  Prior approval or authorization dates must be respected at all times.  Failure to respect such dates may result in non‑payment of claims.  For non‑payment in a denture case to be avoided, the date of final impression or of insertion may be used as the date of service if it falls within the patient's eligibility period and does not precede the date of authorization or of prior approval.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; S.L. 1985, c. 479, s. 86;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Transferred from 10A NCAC 22O .0211 Eff. May 1, 2012.