MedicaidAdministrativeMedium impact
Updated Utilization Review Requirements for Eligible Inpatient Hospitals
NC Medicaid - NCDHHS·NC·Prior Authorization
We identified it
Sep 15, 2026
Summary
NC Medicaid is clarifying signature requirements for Utilization Review (UR) Plans submitted by eligible inpatient hospitals every four years under Clinical Coverage Policy 2A-1. UR plan signatures—whether wet or electronic—must now include the full name of the signer and the date signed in month/day/year format. This applies to hospital administrator or authorized committee member signatures.
Action Required
REQUIREMENTS:
- Monitor the NC Medicaid Program Specific Clinical Coverage Policies webpage for the official 2A-1 Acute Inpatient Services policy update to confirm effective date and implementation timeline.
- Hospital compliance/administrative staff (not billing team directly) must ensure that all future UR Plan submissions to NC Medicaid include: (1) full name of signer, (2) date in month/day/year format, and (3) valid signature (wet or electronic).
- Billing team should communicate this requirement to hospital administrators and the committee responsible for UR Plan submissions to ensure compliance before the next 4-year renewal submission.
- Contact NC Medicaid Contact Center at 888-245-0179 if clarification is needed on signature formatting or submission requirements.
- CONSEQUENCE: UR Plans with incomplete or improperly formatted signatures may be rejected by NC Medicaid, potentially impacting hospital participation status and authorization processes for inpatient admissions.