Provider Disputes or Appeals
CareSource North Carolina Co.® provides the following opportunities for you to request review of claim or authorization details. Actions available after a denial include:
A claim appeal is a written request by a provider to review the denial or payment of a claim due to processing errors.
A clinical appeal is a written request by a provider to review a prior authorization denial with a clinical decision regarding medical necessity on behalf of the member. Clinical denials are issued from the CareSource North Carolina Co.® Utilization Management department. You may submit clinical appeals pre- or post-service. All pre-service appeals are clinical appeals and require the member’s signed and dated Appointment of Representative (AOR). For more information about requirements for pre-and post-service appeals, view the Clinical Appeals section.
Updates & Announcements
For any questions regarding CareSource North Carolina Co.’s processes, please contact Provider Services at 1-833-230-2101, Monday through Friday, 8 a.m. to 6 p.m. Eastern Standard Time (EST).