Coverage profile
Work North Carolina Medicaid across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with North Carolina Medicaid.
Currently not answering
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with North Carolina Medicaid.
Available
Other aliases
Also known as
- 10156
- 12K23
- 1561250855
- 377
- CKNC1
- DNC00
- NCMCD
- NCTRACKS
- SKNC0
- Medicaid North Carolina
- NC Medicaid
- NCDHHS
- NCMEDICAID
2027 maternity billing research
When does North Carolina Medicaid change OB/GYN billing?
Confirmed 2027 guidance
Beginning Sept. 1, 2026, NC Medicaid Direct and NC Medicaid Managed Care providers are encouraged to use E/M 99202-99215 with TH for prenatal or postpartum care. The bulletin identifies first prenatal visits after confirmation and antepartum visits where delivery and/or the postpartum visit is anticipated after Jan. 1, 2027. On Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule and new AMA maternity billing codes become effective. Clinical Coverage 1E-5 is being revised.
- Transition start
- 2026-09-01
- Billing start
- 2027-01-01
- Published
- 2026-07-10
- Current As Of
- August 2026
Scope: Maternity medical billing under NC Medicaid Direct and NC Medicaid Managed Care.
Transition to AMA maternity CPT 2027 code changes. Verify the payer source before claim submission.
Frequently asked questions
North Carolina Medicaid payer FAQs
How do I check claim status with North Carolina Medicaid?
Providers check North Carolina Medicaid via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
What is the payer ID for North Carolina Medicaid?
The primary payer ID for North Carolina Medicaid is NCMCD. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What are the 837 payer IDs for North Carolina Medicaid?
The 837P and 837I payer ID for North Carolina Medicaid is NCMCD via Stedi.
What is the 835 payer ID for North Carolina Medicaid?
The 835 payer ID for North Carolina Medicaid is NCMCD via Stedi.
What is the 270 payer ID for North Carolina Medicaid?
The 270 payer IDs for North Carolina Medicaid are NCMCD via Stedi and NCMCD via Availity.
What is the 276 payer ID for North Carolina Medicaid?
The 276 payer IDs for North Carolina Medicaid are NCMCD via Stedi and NCMCD via Availity.
What state does North Carolina Medicaid operate in?
North Carolina Medicaid operates in NC.
Routing reference
North Carolina Medicaid payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | North Carolina MedicaidSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | NCSource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | NCMCDEnrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | NCMCDEnrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | NCMCDEnrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | NCMCDSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | NCMCDEnrollment requiredSource: Availity payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDStedi | NCMCDEnrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDAvaility | NCMCDEnrollment requiredSource: Availity payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: North Carolina Medicaid. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer ID; matched record: MEDICAID NORTH CAROLINA. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
North Carolina Medicaid phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Pharmacy phone
- (800) 638-3302UNITEDHEALTHCARE OF NORTH CAROLINA
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(800) 638-3302 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(833) 552-3876 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(844) 594-5072 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(844) 594-5084 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(866) 799-5318 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient |
| phone(877) 234-4274 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(877) 283-6380 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(888) 738-0004 | PharmacyBenefit context: Active Coverage |
| Occupational Therapy, Physical Medicine, Speech Therapy, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Professional (Physician) Visit - Outpatient, Professional (Physician) Visit - Home, Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Medical Care, Durable Medical Equipment Purchase, Ambulatory Service Center Facility, Durable Medical Equipment Rental, Surgical, Second Surgical Opinion, Health Benefit Plan Coverage, Chiropractic, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Immunizations, Routine Physical, Family Planning, Emergency Services, Pharmacy, Brand Name Prescription Drug, Generic Prescription Drug, Podiatry, Professional (Physician) Visit - Office, Professional (Physician) Visit - Inpatient, Skilled Nursing Care, Substance Abuse, Vision (Optometry), Psychotherapy, Psychiatric - Inpatient, Psychiatric - Outpatient, Cardiac Rehabilitation, Pediatric, Mental Health, Urgent Care, Durable Medical Equipment Purchase, Durable Medical Equipment Rental, Health Benefit Plan Coverage, Diagnostic X-Ray, Oral Surgery, Home Health Care, Hospice, Hospital, Hospital - Inpatient, Diagnostic Lab, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Hospital - Ambulatory Surgical, Long Term Care, Radiation Therapy, MRI/CAT Scan, Newborn Care, Well Baby Care, Anesthesia, Diagnostic Medical, Dialysis, Chemotherapy, Surgical Assistance, Family Planning, Emergency Services, Generic Prescription Drug |
| phone(800) 849-6127 | Behavioral healthBenefit context: Active Coverage |
| Mental Health |
| phone(866) 998-2597 | Behavioral healthBenefit context: Active Coverage |
| Mental Health |
| phone(888) 235-4673 | Behavioral healthBenefit context: Active Coverage |
| Mental Health |
| phone(800) 688-6696 |
|
Phone and fax numbers sourced directly from the payer response