North Carolina: Get accurate rates for non-routine infant care

This is a reminder of the 2022 Medicaid requirement from the state of North Carolina Department of Health and Human Services for notification of non-routine newborn care. Non-routine newborn care does not require prior authorization but does require notification within 24 hours of rendering care. A medical necessity review will take place when the notification is received.

Conditions that may require non-routine newborn care include the following examples: 

• Unusual jaundice
• Prematurity
• Sepsis
• Respiratory distress

Upon discharge, mothers must submit a separate notification if their infant remains in the hospital. This is also subject to medical necessity review.

What this means for you

Within 24 hours of providing non-routine care to an infant, you must submit notification using one of the following methods:

• Online: Use the Prior Authorization and Notification tool
• Electronic Data Interchange (EDI): Use EDI 278N transaction

If we don’t receive timely notification, the normal newborn contract rate in your participation agreement will apply. For information on this and on how to file an aggrievance if you disagree with the reimbursement amount, see Chapter 12 in the 2024 Care Provider Manual.

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