One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. Please refer to checkwrite schedules available on NCTrack's Providers page under Quick Links for cut-off timing for submitted claims. Please allow 5 business days for Liberty Healthcare to research your request. To learn more, view our full privacy policy. Type a topic or key words into the search bar, Select a topic from the available list of Categories. Services must be provided according to state and federal statutes, rules governing the NC Medicaid Program, state licensure and federal certification requirements, and any other applicable federal and state statutes and rules. pgESm\pbEYAw]k7xVv]8S>{E}V%(d It will save you valuable time if you verify the following information when encountering issues trying to bill for PCS: Via NCTracks Provider Portal or by calling 1-800-688-6696. For claims and recoupment please contact NC Tracks at 800-688-6696. FY22_DMH BP Concurrency Table.xlsx. It is oneof the Divisions of the N.C. Department of Health and Human Services served by NCTracks. In North Carolina, the State Fiscal Year is from July 1 to June 30. The service must be provided according to service limits specified and for the period documented in the approved request unless a more stringent requirement applies. Raleigh, NC 27699-2000. RECIPIENTS - Click on the Recipients tab above to enter the Recipient Portal. JFIF ` ` C If the denial results in the rendering provider (or his/her/its agent) choosing . 6 0 obj State Government websites value user privacy. Reversal of a paid claim, either at the provider's request or as part of an automated recoupment. $.' The amount of the claim charge that Medicaid will pay for a particular service; the allowed amount is usually the lesser of the charged amount or a maximum allowed associated with the service. For more information, see the ORHCC website. Third Party Liability. endobj endobj Listed below are the most common error codes not handled by Liberty Healthcare of NC. Medicaid reviews requests according to the clinical coverage policy for the requested service, procedure or product. To learn more, view our full privacy policy. However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. The Delay Reason Codes currently accepted in NCTracks are third-party processing delay (#7) and the original claim was rejected or denied due to a reason unrelated to the billing limitation rules (#9). A lock icon or https:// means youve safely connected to the official website. All services provided on or after January 1, 2013 must be billed using the new PCS codes. For more information about TPAs, see the Trading Partner Information page of the NCTracks Provider Portal. If you have verified this information within QiRePort and NCTracks, but are still encountering issues, you may submit a Request for Prior Approval (PA) Research Form to Liberty Healthcare for further assistance. NCTracks uses the ANSIASC X12 standards, which includes transations for claim submission, eligibility verification, and remittance advice, among others. Federal regulations that govern the Medicaid program under Title XIX (19) of the Social Security Act. endobj endobj <> endobj State Government websites value user privacy. EFT is the electronic exchange of money from one financial institutionaccount to another through computer-based systems. Secure websites use HTTPS certificates. Health plans are expected to resolve complaints promptly and furnish a summary of final resolution to NC Medicaid. Other insurance companies responsible for medical coverage; their claims must process and pay or deny before State processing. The Ombudsman service is separate and apart from the Health Plan Provider Grievances and Appeals process. If the Provider Affiliation information is incorrect, the affiliated individual provider or the Office Administrator for the affiliated individual provider must update the group affiliation. hbbd```b``3@$Sd9 "`m This status indicates your Prior Approval (PA) is still under review. Listed below are the most common error codes not handled by Liberty Healthcare of NC. NCTracks is updating the claims processing system as inappropriately denied codes are received. 3 0 obj 1 0 obj <> Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim. It could also be that this provider is requiring a legacy ID. Welcome to NCTracks, the multi-payer Medicaid Management Information System for the N.C. Department of Health and Human Services (N.C. DHHS). FY22 DMH BP Hierarchy. The date that the request is submitted affects payment authorization for services that are denied, reduced or terminated. For questions on the HOSAR payment contact NCTracks Call Center; 800-688-6696 or NCTracksprovider@nctracks.com This blog is related to: Bulletins All Providers NCTracks is updating the claims processing system as inappropriately denied codes are received. Certain nurse practitioner (NP), physicians assistant (PA) and certified nurse midwives (CNM) services have received denials due to incorrect billing codes since July 2013. Medicaid claims, except inpatient claims and nursing facility claims, must be received by NCTracks within 365 days of the first date of service to be accepted for processing and payment. %PDF-1.5 Prior Approval (a.k.a. 2001 Mail Service Center stream Visit RelayNCfor information about TTY services. Providers who use NCTracks are required to have an NPI. 0 There are several types of TINs that vary according to taxpayer category. Payment from NCTracks to providers is made through EFT. For claims and recoupment please contact NC Tracks at 800-688-6696. endobj A. endobj American Bankers Association. Exceptionsmay apply. FY22_DMH BP Eligibility Criteria.pdf. PROVIDERS - Click on the Providers tab above to enter the Provider Portal. ",#(7),01444'9=82. The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. read on Provider User Guides & Training, This section is intended to help NC DHHS providers understand the online Re-credentialing/Re-verification process in NCTracks. A Trading Partner Agreement (TPA), defined in 45 CFR 160.163 of the transaction and code set rule, is a contract between parties who have chosen to exchange information electronically. For more information, see the NCDHHSwebsite. Prior Authorization)- For more information regarding Prior Approval and NCTracks, see the Prior Approval webpage on the Provider Portal. Once service records are updated, providers should receive payment at the previous level of service for the duration of the appeal process. Does the modifier on the PA match the modifier assigned to your agency in NCTracks? Does your beneficiary have active Medicaid? For more information, see the Trading Partner Information webpage on the Provider Portal. <> If contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve. A. For more information, see CCNC/CA, Protected Health Information - information about health status, provision of health care, or payment for health care that can be linked to a specific individual. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone.Phone: 800-723-4337, This page was last modified on 01/25/2023, An official website of the State of North Carolina, Rules and exceptions for providers billing beneficiaries, NCTracks claims processing and provider enrollment system. The American National Standards Institutereviews, evaluates, and make recommendations relating to electronic transactions for certain industries, including health insurance,and the format of those data submissions. All billing for dates of service January 1, 2013 and later must be done with the Procedure Code 99509 and one of the following modifiers: Q. A lock icon or https:// means youve safely connected to the official website. 1 0 obj Providers can access the AVRS by dialing 1-800-723-4337. TheNC Medicaid Help Centeris an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. endstream Below are some of the sessions most helpful for Managed Care launch. The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. Secure websites use HTTPS certificates. NCTracks Contact Center Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. Usage: This code requires use of an Entity Code. It is the responsibility of the provider to clearly document that the beneficiary has met the clinical coverage criteria for the service, product or procedure. For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page. Previously Denied Billing Codes for NP, PA and Certified Nurse Midwives. Claims submitted for prior-approved services rendered and billed by a different provider will be denied. May refer to Fiscal Year-to-Date (FYTD) or Calendar Year-to-Date (CYTD), Provider Re-credentialing/Re-verification FAQs, Drug Enforcement Administration (DEA) Certification FAQs, Claims Pended for Incorrect Location FAQs, Office Administrator, User Setup & Maintenance FAQs, Ordering, Prescribing, Rendering or Referring Provider (OPR) FAQs, Behavioral Health Provider Enrollment FAQs, Disproportionate Share Hospital Data FAQs, New Medicare Card Project (formerly SSNRI) FAQs, Common Enrollment Application Issues FAQs, Currently Enrolled Provider (CEP) Registration, Provider Re-credentialing/Re-verification, Provider Policies, Manuals, Guidelines and Forms, New Medicare Card Project (formerly SSNRI), https://medicaid.ncdhhs.gov/providers/programs-and-services/community-care-north-carolinacarolina-access-ccncca, website for the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, 40. EFT information may be updated by authorized provider personnel using the secure. NCTracks is the multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services. Providers with questions can contact the CSRA Call Center at 1-800-688-6696 (phone); 1-855-710-1965 (fax) or NCTracksprovider@nctracks.com (email). A. May be done automatically as part of claims reprocessing. A claim in this state is said to be "pended.". 14 0 obj read on Provider Re-credentialing/Re-verification, Provider Re-credentialing/Re-verification, North Carolina Department of Health and Human Services. Although there are many available, the following fact sheets will be most useful for Managed Care go-live and can be found on theFact Sheet page: In addition to the DHHS Combined PHP Quick Reference Guide, NC Medicaids Managed Care Prepaid Health Plans (PHPs) created quick reference guides to include the most current and comprehensive information for providers. All requests for PA must be submitted according to DMA clinical coverage policiesand published procedures. Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. A Primary Care Physician (or Primary Care Provider) is a provider who has responsibility for oversight of the medical care of a recipient. A lock icon or https:// means youve safely connected to the official website. Therefore, claims for orthodontic records (D0150, D0330, D0340, and D0470) or orthodontic banding (D8070 or D8080) rendered for beneficiaries under MPW eligibility are outside of policy limitation and are subject to denial/recoupment. A link to the Remittance Advice is posted to the Message Center Inbox in the secure NCTracks Provider Portal. . 2001 Mail Service Center Likewise, responses may also be delivered through either email or by phone. Maintenance Request Status Maintenance Request Form 11/16/2022 Filter by code: Reset Filter codes by status: To Be Deactivated Deactivated It has three separate portals for specific internet access to different sectors of the business: Providers, Recipients and internal operations needs. Each health plan has a grievance and appeal process for providers, separate from the process for beneficiaries, which can be found in each health plans Provider Manual, linked on the Health Plan Contacts and Resources Page. Suspended (Prior Approval), Provider Policies, Manuals, and Guideline page, North Carolina Department of Health and Human Services. For more information, see the NC DHBwebsite. Previously referred to as the Medicaid ID. This allows a claim to be corrected and processed without being resubmitted. The person receiving services from a provider. Place of Service Indicator Codes Updated Some claims have also denied for Place of Service (POS) mismatch. 2455. endobj The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement. %PDF-1.6 % <> An official website of the State of North Carolina, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). A payment received from a Medicaid provider due to an erroneous payment. Ensure beneficiary eligibility on the date of service, Guarantee that a post-payment review that verifies a service medically necessary will not be conducted. <> Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal. Providers must request authorization of a continuing services 10 calendar days before the end of the current authorization period for authorization to continue without interruption for 10 calendar days after the date an adverse decision notice (change notice) is mailed to the Medicaid beneficiary or to the beneficiary's legal guardian and copied to the provider. FY22_DMH Budget Criteria.xlsx. A provider must have thenine-digit ABA routing number for their bank and their checking account number to sign up for electronic funds transfer (EFT) of payments from NCTracks. stream d4-L+_ocHkI.J`zF8;|[&^#)(Wq'ld\Ks0UM[o/6r1-=$_7Ig05J_ P5-I1(1TsAs4xZjez(OB)Z.VpE!.faM}Mqy W2i)U7xo)> R=q[ Links to the Health Plan training webpages have also been added on the Provider Playbook Training Courses webpage. To learn more, view our full privacy policy. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> As NC Medicaid moves forward with the implementation of NC Medicaid Managed Care, it is important enrolled providers use these resources to thoroughly review their individual and organization provider enrollment information and submit changes as needed using the Manage Change Request process. A Remittance Advice is generated during each checkwrite cycle for every NPI. In order to allow NC Tracks time to update service records, providers should wait 10 days from the date the client enters an appeal before submitting billing for services provided on and after the effective date indicated in the beneficiary's notice of service denial or reduction. Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or the Medicaid Managed Care Provider Ombudsman at 866-304-7062 (NEW NUMBER). DHHS currently has eight LME-MCOs operating under the 1915 b/c Waiver. Visit NCTracks Website. This includes services to beneficiaries who appealed a reduction or denial in services under the PCS Program and are currently authorized for MOS under the PCS Program. endobj NCTracks AVRS . A. The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. 9 0 obj NC Department of Health and Human Services The identification number assigned to a recipient of services from one or more Divisions of the N.C. Department of Health and Human Services (NCDHHS). To learn more, view our full privacy policy. NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). A submitted claim that has either been paid or denied by the NCTrackssystem. State Government websites value user privacy. Office Administrator - The owner or managing employee of a provider organization responsible for maintainingthe provider record. N255 Missing/incomplete/invalid billing provider taxonomy. To update your information, please log into NCTracks (https://www.nctracks.nc.gov) Secure Provider Portal and utilize the Managed Change Request (MCR) to review and submit changes. There are some critical errors, such as wrongNPI or recipientID that cannot be corrected by an adjustment, in which case the provider would void the original claim and may submit a replacement claim. If, after using the NC Medicaid Help Center, the inquiry remains unresolved, use the below table to direct the question appropriately: Provider Enrollment inMedicaid or North CarolinaHealth Choice, To update your information, please log intoNCTracks(https://www.nctracks.nc.gov)provider portal to verify your information and submit a MCR or contact the GDIT CallCenter., Health Plans Contact Info here:https://medicaid.ncdhhs.gov/transformation/health-plans/health-plan-contacts-and-resources, Provider to PHP ContractingConcerns or Complaints, Email:Medicaid.ProviderOmbudsman@dhhs.nc.govPhone: 866-304-7062, NCTracksCall Center at 800-688-6696 orlog intoNCTracks(https://www.nctracks.nc.gov [nctracks.nc.gov]) provider portal to update yourinformation, submit a claim, review claims status, request a prior authorization orsubmit a question., Recipient Eligibility, ClaimsProcessing, BillingQuestions, Health Plans Contact Info here:https://medicaid.ncdhhs.gov/transformation/health-plans/health-plan-contacts-and-resources, What does the MedicaidContact Center helpproviders do? The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. Are you billing within the approved effective dates. NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). A Taxpayer Identification Number (TIN) is a number used by the Internal Revenue Service (IRS) to record and track tax payments. As of April 1, 2023, all NC Health Choice beneficiaries with active eligibility will be moved to Medicaid, providing them access to Medicaid services that are not currently covered under NC Health Choice. For billing information specific to a program or service, refer to theClinical Coverage Policies. A TPA is required to submit electronic ASC X12 transactionsto NCTracks. The Ombudsman will also investigate and address complaints of alleged maladministration or violations of rights against the health plans. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 9 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Every NPI must have an OA, but a single OA may be responsible for multiple NPIs. DHB includes Medicaid. To learn more, view our full privacy policy. Recipients must be eligible under one or more of the programs covered by the Divisions of the N.C. Department of Health and Human Services supported by NCTracks. 242 0 obj <>stream This is a glossary of frequently used acronyms and terms associated with NCTracks. RFA&I:@aLzCOq'xO!b?'J(T+EF?o\J4%YvtO#i5OLv.JG &eRD&~KdS H"'xUU,x3K cC_f ILfB&=aOnnQo+H}h9736 G 7E&x}`)k\ v33M`zKR@;)~ft?N( rzXk'vHNK9:2A8faZ)zJ\2#4b9:_8]xE(c"8D `M Topics covered: pharmacy and durable medical equipment, behavioral health, transitions of care, specialized therapies, quality measures, network adequacy, provider directory, billing, incentive payments, clinical coverage policy updates, and more. endobj If active, this is the taxonomy that should be used on claims. 3 0 obj Division of Public Health. <> 9. Providers can access the AVRS by dialing 1-800-723-4337. For prescription drugs requiring PA, a decision will be made within 24 hours of receipt of the request. <> They include the Social Security Number (SSN) and Employee Identification Number (EIN). All levels of taxonomies are visible in NCTracks but the selected taxonomy is the one displayed as indicated below (I.e. It has three separate portals for specific internet access to different sectors of the business: Providers, Recipients and internal operations needs. Assessing Eligibility for the North Carolina Medicaid Personal Care Services, Request for Prior Approval (PA) Research Form, In-Home Care Agencies, Beneficiary Under 21 Years, In-Home Care Agencies, Beneficiary 21 Years and Older, Supervised Living Facilities for adults with MI/SA, Supervised Living Facilities for adults with I/DD, billing provider is not the beneficiary's Carolina Access PCP, referring NPI does not match the beneficiary's eligibility file. Holding of a claim for another checkwrite cycle so that eligibility,budget, or otherissues can be corrected. In combination, these reports allow all providers to confirm the information visible to NC Medicaid beneficiaries as each utilize the Medicaid and NC Health Choice Provider and Health Plan Look-up Tool to find participating provider information, and if applicable, enroll in NC Medicaid Managed Care. External Code Lists External Code Lists back to code lists Claim Status Codes 508 These codes convey the status of an entire claim or a specific service line. Federal regulations that govern theState Children's Health Insurance Program under Title XXI (21)of the Social Security Act, also known as North Carolina Health Choice (NCHC). endobj (claim numbers), denial codes, etc., the more help the NCTracks team will . What error codes need to be handled by NC Tracks? PROVIDERS - Click on the Providers tab above to enter the Provider Portal.RECIPIENTS - Click on the Recipients tab above to enter the Recipient Portal.STATE AND FISCAL AGENT STAFF - Click on the Operations tab above to enter the Operations Portal and ShareNET. %%EOF DHB includes Medicaid. Side Nav. <> The NC Medicaid Program requires provider claims payments to be by electronic funds transfer (EFT). State Government websites value user privacy. The provider must use the taxonomy approved on their NC Medicaid provider record. The Provider Directory Listing Report, as well as the Provider Affiliation Report, is available to all actively enrolled Medicaid and NC Health Choice providers. Raleigh, NC 27699-2000. Retroactive prior approval is considered when a beneficiary, who does not have Medicaid coverage at the time of the procedure, is later approved for Medicaid with a retroactive eligibility date. 2 0 obj For more information, see the NC DMH/DD/SAS website. If the beneficiary has a current appeal in QiReport, Liberty can answer questions regarding appeals. hb```f``Z {AX,X9pHQuu4~hLGGPd`1@,65A9I:Ac+XDk\X"E]Q|S0`refb`w0)[( , This is the typical initial state of a PArequest thathas been submitted to NCTracks. Medicaid researches requests to determine the effectiveness of the requested service, procedure or product to determine if the requested service is safe, generally recognized as an accepted method of medical practice or treatment, or experimental/investigational. This status indicates that your Prior Approval (PA) is new and being reviewed by a clinical specialist for a decision. An official website of the State of North Carolina, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing, Mental Health, Development Disabilities and Substance Abuse Services, FY22_DMH Service Array with COVID-19 Services.xlsx. Providers needing additional assistance with updating the information on their NCTracks provider record may contact the NCTracks Contact Center at 800-688-6696. For all other types of PA requests, Medicaid will make every effort possible to make a decision within 15 business days of receipt of the request unless there is a more stringent requirement. Infant-Toddler Program of the NC Division of Public Health, Local Management Entity responsible for behavioral health providers. Federal regulations that govern the Medicare program under Title XVIII (18)of the Social Security Act. Transition of Care for beneficiaries receiving long-term services and supportsAn overview ofhow NC Medicaid Managed Care impactsbeneficiaries with disabilities and older adults who are receiving Long-Term Services and Supports (LTSS). Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks. A wide variety of topics have been covered with sessions including an open question and answer period. Secure websites use HTTPS certificates. This table of codes are the allowable POS for billing G9919. 11 0 obj To use this new tool: More information about the NC Medicaid Help Center is available here. Electronic Data Interchange refers to the electronc exchange of information between computer systems using a standard format. 282N00000X and 3112A0620X). NC Medicaid Managed Care Billing Guidance to Health Plans. The NCTracks team is offering another in-person Provider Help Center on March 7 in Raleigh. <>/F 4/A<>/StructParent 1>> Visit RelayNCfor information about TTY services. The PCS Provider shall provide a qualified and experienced RN, or other professional as specified in licensure rules to supervise personal care services and write or adjust the new weekly POC so that it can be implemented as soon as the new service level is effective. . read on Getting Started With NCTracks, This section includes User Guides and Fact Sheets designed to help N.C. DHHS providers understand how to use NCTracks, as well as information about Provider Training. State Government websites value user privacy. NCTracks staff from provider enrollment, provider relations, claims, and prior approval will be available to assist NC providers with questions or concerns regarding NCTracks. The ordering provider is responsible for obtaining PA; however, any provider can request PA when necessary. Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. For more information, see the website for the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS), Medicaid Management Information System - the mechanized claims processing and information retrieval system which states are required to have for the Medicaid program, NCTracks is a multi-payer system that consolidated several claims processing platforms into a single solution for multiple NCDHHS divisions. endobj 12 0 obj However, providers can also submit paper forms via mail or fax. For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page. The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: *PHP may be updating their denial/rejection code description. ORHCC is part of the N.C. Department of Health and Human Services supported by NCTracks. 4 0 obj Overridesmay begranted and can be requested using theMedicaid Inquiry ResolutionForm under the Provider Forms section of the Provider Policies, Manuals, and Guideline page of the NCTracks Provider Portal. <> A. endobj Once children in NC Health Choice are enrolled in Medicaid, they will no longer be subject to cost sharing. Check NCTracks for the Beneficiary's enrollment (Standard Plan or NC Medicaid Direct) and health plan. % A lock icon or https:// means youve safely connected to the official website. Primary care case management program through the networks of Community Care of North Carolina. Welcome to NCTracks, the multi-payer Medicaid Management Information System for the N.C. Department of Health and Human Services (N.C. DHHS). Providers may use the NCTracks managed change request (MCR) process, available in the Secure NCTracks Provider Portal, to modify any provider record or service location information as well as individual to organization affiliations.
