Providers should use the latest version of the sterilization consent form to ensure that the correct version of the consent form is submitted to the NC Medicaid fiscal agent.
NCTracks is reminding providers that the sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website was updated in 2023. It is available in English and Spanish. These links can also be accessed from the North Carolina (NC) Medicaid website https://medicaid.ncdhhs.gov/forms.
Instructions for Federal Sterilization Consent Form
The NCTracks team has put together detailed instructions for filling out the Federal Sterilization Consent form, complete with explanations for each field of the form, to better help providers submit accurate information and eliminate errors that may cause denials. Providers are encouraged to download this PDF guide to learn from and reference when completing the form: Instructions for Federal Sterilization Consent Form
Instructions for Filling Out a Hysterectomy Statement
Detailed instructions on how to complete the Hysterectomy Statement correctly can be found here. A downloadable version of the instructions can also be found to the right of the linked page.