10A NCAC 27A .0304. CLAIMS REVIEW PROCEDURES

(a)  The LME shall review the claim to determine if it is clean.  The determination shall be based on whether the claim is submitted as follows:

(1)           the claim is submitted in one of the formats as set forth in Rule .0303 of this Section; and

(2)           the information requested in each element of the selected format is complete.

(b)  When a claim meets the requirements as set forth in Paragraph (a) of this Rule, it shall be considered a clean claim. (c)  The LME shall deny a claim that does not meet the requirements as set forth in Paragraph (a) of this Rule.  The LME shall notify the provider of the denied claim. The notification shall specify the reason for denial and include the steps to be followed for resubmission.

 

History Note:        Authority G.S. 122C-112.1(a)(32); S.L. 2006-142;

Eff. May 1, 2008.