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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 instruction manuals and Alliance Medicaid and non-Medcaid rate sheets.

person holding pencil near laptop computer

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 a number of other documents.

We’ll also tell you how to get in touch with the Alliance Provider Helpdesk if you need further assistance.

Alliance Health offers Claims Technical Assistance sessions each Tuesday morning from 9:30 am to noon. Providers may contact their assigned Claims Research Analyst or the general Claims queue (919-651-8500, option 1) to schedule a session. When you attend a Claims Technical Assistance session, please bring: your laptop, your AlphaMCS provider login (username and password), and any claims information you want to review.

Eligibility and Enrollment

The following documents are provided here to clarify the requirements for enrollment and client update requests for member admissions in Alpha. Please be advised that members with Medicaid are automatically uploaded into the AlphaMCS system from NC Tracks and an enrollment request in Alpha 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.

Eligibility and 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
Electronic Connectivity Request

Rate Sheets

This page was last reviewed for accuracy on 08/05/2021