North Carolina Prior Authorization Requirements
A guide to prior authorization rules, turnaround times, and laws for medical practices operating in North Carolina (NC).
PA Turnaround Times
Standard Requests
14 calendar days
Urgent / Expedited
72 hours
Gold Card Law
North Carolina enacted gold card legislation exempting providers with high PA approval rates from PA requirements for certain services.
PA Reform Legislation
North Carolina has enacted PA reform including gold card provisions.
Key Regulations
- Gold card exemption for high-performing providers
- Standard PA turnaround of 14 calendar days
- Urgent requests within 72 hours
North Carolina Medicaid PA
NC Medicaid Managed Care (NC Medicaid) transitioned to managed care. PA is administered by MCOs.
Recent Changes (2025-2026)
- Gold card legislation implementation
- Medicaid managed care transition affecting PA workflows
Top Payers in North Carolina
State Regulatory Body: North Carolina Department of Insurance
File PA complaints or appeals through your state insurance department.
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