Claims Information and Resources

On this page, you’ll find a variety of information and resources to assist you in the claims preparation and submission process, including eligibility and enrollment, instruction manuals, Alliance Medicaid and IPRS rate sheets, and several other documents. We’ll also tell you how to contact the Alliance provider helpdesk if you need further assistance.

General Information

The Claims and Enrollment Team now invites you to take our brand-new e-learning course, which provides an overview of the claims filing and enrollment process at Alliance Health.

Please click this link to access KnowledgePoint and join the training at your own pace. This 45-minute module provides an overview of Eligibility, Enrollment, and Claims and is recommended for Providers new to the Alliance Network. If you have trouble or need assistance registering your account, please email [email protected]. If you do not have an account, you can email [email protected] directly, select the “register account” option when you click the link, or use the SSO option that now integrates with Okta.

Claims 1:1 Assistance

This is not an informational group session. The Claims department offers virtual sessions for individualized assistance with claims-related matters. These sessions are specifically designed for agency, organization, or company-related issues concerning claims submissions and denials. Please note that space is limited each week, and registration is required. Use the link below to register for the preferred date you would like to attend. Providers and staff should join at the beginning of the call to help ensure each session starts on time.

These sessions are held at various times on Monday, Wednesday, and Friday. 

• For providers with KnowledgePoint accounts
• For providers without KnowledgePoint accounts (registration code is newuser)

The following documents are provided here to clarify the requirements for enrollment and client update requests for member admissions in ACS. Please be advised that members with Medicaid are automatically uploaded into ACS from NC Tracks and an enrollment request in ACS is not needed for these members.

Every member enrolled with Alliance is evaluated to determine their ability to pay for state-funded services. The combination of a member’s adjusted gross income and the number of dependents will show if they have the ability to pay. A member meets financial eligibility if their household income is at or below 300% of the federal poverty level and they have no assets or third-party funding or insurance available to pay for services. If a member’s income exceeds this amount, the individual will be required to pay 100% of the cost for the state-funded services provided to him or her.

Questions may be directed to the provider helpdesk at (919) 651-8500, Option 3.

Enrollment and Client Update Overview
Enrollment Guidelines
Client Update Guidelines
DMH Benefit Plan/Diagnosis and Service Arrays 
Benefit Plan (Target Population) Descriptions
Federal Poverty Level
Medicaid Eligibility Categories
Residency Verification Attestation Form
Medicaid Direct Tailored Care Management Provider Claims Billing Guidance