Discontinuation of Medical/Surgical PA form DMA 372-118PA

Effective December 18, 2016, NCTracks will no longer accept Prior Approval (PA) form DMA 372-118 requests by fax or mail for services. In addition, NCTracks will no longer accept requests for exceptions to the legislative visit limit by fax or mail. These requests can only be submitted on the NCTracks secure provider portal. No submissions will be accepted via fax or mail using a paper form. (The form will be removed from the NCTracks Prior Approval web page .) Providers who continue to fax or mail these forms will be sent a rejection letter stating the form is no longer accepted.