State Government websites value user privacy. Welcome to NCTracks, the multi-payer Medicaid Management Information System for the N.C. Department of Health and Human Services (N.C. DHHS). <>
This is a glossary of frequently used acronyms and terms associated with NCTracks. NCTracks uses the ADA Form for dental prior approval and claim submission. The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. 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. FY22_DMH Service Array with COVID-19 Services.xlsx. 9 0 obj
This allows a claim to be corrected and processed without being resubmitted. NCTracks AVRS All services provided on or after January 1, 2013 must be billed using the new PCS codes. endobj
Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. A. Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks. There is an abundance of resources provided by DHHS and the health plans for providers to get help with an issue or for information around a particular question or concern. Prior approval is issued to the ordering and the rendering providers. NCTracks is updating the claims processing system as inappropriately denied codes are received. For more information, see the Trading Partner Information webpage on the Provider Portal. It is one of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. %PDF-1.6
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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. endobj
Listed below are the most common error codes not handled by Liberty Healthcare of NC. A Primary Care Physician (or Primary Care Provider) is a provider who has responsibility for oversight of the medical care of a recipient. Previously referred to as the Medicaid ID. Key milestone dates, where to turn for help, Provider Playbook, PHP quick reference guides, webinars, Provider Directory, Help Center and Provider Ombudsman. If the beneficiary does not have an appeal in QiReport and the agency has not received a MOS letter, please contact the Office of Administrative Hearings (OAH) at 984-236-1850 to verify if the beneficiary filed an appeal within the 30 days of the date of the letter. Suspended (Prior Approval), Provider Policies, Manuals, and Guideline page, North Carolina Department of Health and Human Services. <>
For billing information specific to a program or service, refer to theClinical Coverage Policies. 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. A Taxpayer Identification Number (TIN) is a number used by the Internal Revenue Service (IRS) to record and track tax payments. NC Medicaid has checkwrites 50 weeks of the calendar year no checkwrites occur the week of June 30 and the week of Christmas. NCTracks - FY 2022 Documents NCTracks - FY 2022 Documents. 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. The provider must use the taxonomy approved on their NC Medicaid provider record. 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. Transaction Control Number. Electronic Data Interchange refers to the electronc exchange of information between computer systems using a standard format. (claim numbers), denial codes, etc., the more help the NCTracks team will . The Remittance Advice is an explanation to providers regarding paid, pending, and denied claims. 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. denial. The person receiving services from a provider. State Government websites value user privacy. The Provider Directory Listing Report, as well as the Provider Affiliation Report, is available to all actively enrolled Medicaid and NC Health Choice providers. The system-assigned number used to track a claim throughout the processing steps in NCTracks. 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). If contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve. All requests for PA must be submitted according to DMA clinical coverage policiesand published procedures. 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. Additionally, providers will find links to Provider Announcements, User Guides and Frequently Asked Questions. N255 Missing/incomplete/invalid billing provider taxonomy. American Dental Association. 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. 10 0 obj
PROVIDERS - Click on the Providers tab above to enter the Provider Portal. Customer Service Center:1-800-662-7030 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. A lock icon or https:// means youve safely connected to the official website. A link to the Remittance Advice is posted to the Message Center Inbox in the secure NCTracks Provider Portal. Additional information on updating an NCTracks provider record can be found at: https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html. The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. <>
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EFT is the electronic exchange of money from one financial institutionaccount to another through computer-based systems. read on Provider Re-credentialing/Re-verification, Provider Re-credentialing/Re-verification, North Carolina Department of Health and Human Services. Once children in NC Health Choice are enrolled in Medicaid, they will no longer be subject to cost sharing. . For more information, see the NCDHHSwebsite. 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. FY22_DMH Budget Criteria.xlsx. NC Medicaid offers a Provider Ombudsman to assist providers transitioning to NC Medicaid Managed Care by receiving and responding to inquiries, concerns and complaints regarding health plans. D18: Claim/Service has missing diagnosis information. Place of Service Indicator Codes Updated Some claims have also denied for Place of Service (POS) mismatch. endobj
A beneficiary must be eligible for Medicaid coverage on the date the service or procedure is rendered. . 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. However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. 2455. A TPA is required to submit electronic ASC X12 transactionsto NCTracks. 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. Visit RelayNCfor information about TTY services. The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. %PDF-1.5
Exceptionsmay apply. One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. The Medicaid Contact Center isdedicated to assisting with inquiries regardingenrollment, claim status, recipient eligibility and other information neededbyprovidersto support their service toNCDHHS recipients. DHB includes Medicaid. Entity's National Provider Identifier (NPI). 230 0 obj
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Theprovider who referred the patient for the service specified on the submitted claim. endstream
They include the Social Security Number (SSN) and Employee Identification Number (EIN). Usage: This code requires use of an Entity Code. 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. %
State Government websites value user privacy. To learn more, view our full privacy policy. 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. 9. A payment received from a Medicaid provider due to an erroneous payment. 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). 205 0 obj
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Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. An official website of the State of North Carolina, NC Medicaid Managed Care Provider Update June 16, 2021, To update your information, please log intoNCTracks(, )provider portal to verify your information and submit a MCR or contact the GDIT CallCenter., https://medicaid.ncdhhs.gov/transformation/health-, 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., dedicated to assisting with inquiries regardingenrollment, claim status, recipient eligibility and other information neededby, Provider Playbook Training Courses webpage, https://www.ncahec.net/medicaid-managed-care, Managed Care Provider PlaybookTrending Topicspage, https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html, Provider Ombudsman: 866-304-7062 (NEW NUMBER) or at, NC Medicaid Ombudsman: 877-201-3750 or at. The standard for initial filing of claims is up to 12 months from thedate of service. endobj
Other insurance companies responsible for medical coverage; their claims must process and pay or deny before State processing. Just getting started with NCTracks? For more information on PA status codes, see the Prior Approval FAQs. Health plans are expected to resolve complaints promptly and furnish a summary of final resolution to NC Medicaid. 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. 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. Visit NCTracks Website. JFIF ` ` C Listed below are the most common error codes not handled by Liberty Healthcare of NC. For claims and recoupment please contact NC Tracks at 800-688-6696. The Ombudsman service is separate and apart from the Health Plan Provider Grievances and Appeals process. 0
2001 Mail Service Center NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). endobj
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282N00000X and 3112A0620X). Adjustments can be filed up to 18 months following the adjudication of the original claim. <>
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`M The new service level goes into effect either 1 - 10 days from the date of the notice, and this will be specified in the Notice of Decision letter. D19: Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/01/1995 | Stop: 06/30/2007 Once a complete request has been submitted, Medicaid may: Medicaid notifies the provider following established procedures of approvals, including service, number of visits, units, hours or frequency. Prior approval is required for Medicaid for Pregnant Women beneficiaries when the physician determines that services are needed for the treatment of a medical illness, injury or trauma that may complicate the pregnancy. If the denial results in the rendering provider (or his/her/its agent) choosing . All levels of taxonomies are visible in NCTracks but the selected taxonomy is the one displayed as indicated below (I.e. 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). For more information about Carolina ACCESS (CCNC/CA), see the related DHB webpage at https://medicaid.ncdhhs.gov/providers/programs-and-services/community-care-north-carolinacarolina-access-ccncca. A lock icon or https:// means youve safely connected to the official website. <>
These denials are then re-adjudicated by Vaya without action required from the provider. stream
This status indicates your Prior Approval (PA) is still under review. A. Medicaid reviews requests according to the clinical coverage policy for the requested service, procedure or product. A wide variety of topics have been covered with sessions including an open question and answer period. 1 0 obj
Are you billing within the approved effective dates. 2 0 obj
FY22_DMH DX Code Array.xlsx. Beneficiaries who submit an appeal (a request for hearing) within 30 days of the date on the authorization letter are entitled to continue to receive services at the previous level (that was provided before the decision letter was sent, and not to exceed 80 hours per month) while the appeal is pending. Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. Once service records are updated, providers should receive payment at the previous level of service for the duration of the appeal process. xmo6wR|T+27b/4[q4R&i)w'IHe/hw$0]fG'8X,],L}w}{H
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llv>l+M-:>`.C$p}9rLUxi>-f g2d-4`lt KvpnY8A>J&U[**xXCeh}UZ>HF To learn more, view our full privacy policy. stream
This service is intended to represent the interests of the provider community, provide supportive resources and assist with issues through resolution. 242 0 obj
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Claims submitted for prior-approved services rendered and billed by a different provider will be denied. Division of Public Health. One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. Below are some of the sessions most helpful for Managed Care launch. Previously Denied Billing Codes for NP, PA and Certified Nurse Midwives. 3 0 obj
ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are required to use ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2015. Providers who use NCTracks are required to have an NPI. Providers can access the AVRS by dialing 1-800-723-4337. Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code. Division of Health Benefits (new name for the Division of Medical Assistance or DMA). For more information, see the NC DHBwebsite. A lock icon or https:// means youve safely connected to the official website. 3 0 obj
A claim in this state is said to be "pended.". For further assistance, contact us at claims@vayahealth.comor at 1-800-893-6246, ext. Secure websites use HTTPS certificates. American Bankers Association. DHB includes Medicaid. 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. <>
June 17, 2021 | Hot Topics with health plan Chief Medical Officers. 8 0 obj
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To learn more, view our full privacy policy. PA forms are available on NCTracks. Secure websites use HTTPS certificates. %
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FY22 DMH BP Hierarchy. 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 Medicaid webinars and virtual office hours give providers a chance to hear information and guidance on NC Medicaids transition to Managed Care. 4 0 obj
Reversal of a paid claim, either at the provider's request or as part of an automated recoupment. For more information about TPAs, see the Trading Partner Information page of the NCTracks Provider Portal. 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. <>/F 4/A<>/StructParent 1>>
Every NPI must have an OA, but a single OA may be responsible for multiple NPIs. &Vy,2*@q?r 6y@$Y 9 $309}0 b
For prescription drugs requiring PA, a decision will be made within 24 hours of receipt of the request. NC Department of Health and Human Services Maintenance Request Status Maintenance Request Form 11/16/2022 Filter by code: Reset Filter codes by status: To Be Deactivated Deactivated The NC Medicaid Program requires provider claims payments to be by electronic funds transfer (EFT). For more information, see the NC DHBwebsite. NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). Please allow 5 business days for Liberty Healthcare to research your request. NCTracks Call Center: 800-688-6696 Call the health plan for coverage, benefits and payment questions. 1 0 obj
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Year-to-Date. ORHCC is part of the N.C. Department of Health and Human Services supported by NCTracks. A. 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. <>
DHHS has created a comprehensive list of fact sheets to guide providers through Managed Care go-live in the Provider Playbook as part of its commitment to ensure resources are available to help providers and Medicaid beneficiaries transition smoothly to NC Medicaid Managed Care. <>
The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement. endobj
May be done automatically as part of claims reprocessing. Medicaid is the payer of last resort. NC Department of Health and Human Services 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. endobj
Ensure beneficiary eligibility on the date of service, Guarantee that a post-payment review that verifies a service medically necessary will not be conducted. Visit RelayNCfor information about TTY services. Secure websites use HTTPS certificates. 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. Services must be performed and billed by the rendering provider. Does your beneficiary have active Medicaid? <>
The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: *PHP may be updating their denial/rejection code description.
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