Prior Authorization in North Carolina
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for North Carolina practices and billing companies at $1,900 per seat per month. Full time, worked during North Carolina business hours, inside your own system.
What is specific to North Carolina
North Carolina moved most Medicaid members into managed care plans while keeping NC Medicaid Direct for certain populations, and Blue Cross NC remains the largest commercial payer statewide.
North Carolina’s Medicaid programme is North Carolina Medicaid. Practices with a meaningful North Carolina Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a prior authorization seat does in North Carolina
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In North Carolina the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during North Carolina business hours, not queued overnight
For the statute behind all of this — North Carolina’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the North Carolina billing page.
Working North Carolina hours
North Carolina runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on North Carolina hours and nobody else’s.
What it costs in North Carolina
$1,900
Per seat, per month, in US dollars — $22,800 a year for one full-time person, forty hours a week, on North Carolina hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in North Carolina run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in North Carolina
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with North Carolina practices?
Yes. North Carolina accounts are worked during North Carolina office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about North Carolina?
North Carolina moved most Medicaid members into managed care plans while keeping NC Medicaid Direct for certain populations, and Blue Cross NC remains the largest commercial payer statewide.
How long do we have to file a North Carolina Medicaid claim?
365 days from the first date of service (except inpatient and nursing facility claims), measured from the first date of service. Not stated on the page quoted. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: NC Medicaid — Claims and Billing.
When does a North Carolina payer have to pay a clean claim?
30 calendar days after receipt of a claim, for both electronic and paper. The receipt date differs by channel: electronic claims are deemed received the day transmitted, mailed claims the fifth business day after mailing. A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does prior authorization cost in North Carolina?
$1,900 per seat per month — $22,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our North Carolina queue?
North Carolina is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle North Carolina Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. North Carolina Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
More for North Carolina
Next step
One seat on your North Carolina work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com