The Medicaid webinars and virtual office hours give providers a chance to hear information and guidance on NC Medicaids transition to Managed Care. Entity's National Provider Identifier (NPI). To Get A National Provider Identifier (NPI): Did you complete a service plan for the most current assessment for the beneficiary? Claims submitted for prior-approved services rendered and billed by a different provider will be denied. The date that the request is submitted affects payment authorization for services that are denied, reduced or terminated. One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. For more information, see the Trading Partner Information webpage on the Provider Portal. Does your beneficiary have active Medicaid? A lock icon or https:// means youve safely connected to the official website. %%EOF State Government websites value user privacy. For more information about TPAs, see the Trading Partner Information page of the NCTracks Provider Portal. Claims are processed in real time. Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or the Medicaid Managed Care Provider Ombudsman at 866-304-7062 (NEW NUMBER). % For prescription drugs requiring PA, a decision will be made within 24 hours of receipt of the request. 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). The National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). 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. The NCTracks team is offering another in-person Provider Help Center on March 7 in Raleigh. A Remittance Advice is generated during each checkwrite cycle for every NPI. Calls are recorded to improve customer satisfaction. 2455. 132 - Entity's Medicaid provider id. A. 9. 91 Entity not eligible/not approved for dates of service. This is a glossary of frequently used acronyms and terms associated with NCTracks. endobj 0 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. If the beneficiary is under 21 years of age and the policy criteria are not met, the request is reviewed underEarly and Periodic Screening, Diagnosis, and Treatment (EPSDT)criteria. Links to the Health Plan training webpages have also been added on the Provider Playbook Training Courses webpage. 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. To learn more, view our full privacy policy. ORHCC is part of the N.C. Department of Health and Human Services supported by NCTracks. 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. In North Carolina, the State Fiscal Year is from July 1 to June 30. &Vy,2*@q?r 6y@$Y 9 $309}0 b 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. NCTracks is updating the claims processing system as inappropriately denied codes are received. 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). <> 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). Contact NC Medicaid Contact Center, 888-245-0179 Related Topics: Bulletins All Providers Medicaid Managed Care 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). A. Claims specialists may contact providers to alert them of any other denials the provider needs to correct and resubmit. <> Federal regulations that govern the Medicare program under Title XVIII (18)of the Social Security Act. <> 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. Type a topic or key words into the search bar, Select a topic from the available list of Categories. Division of Medical Assistance (DMA) was theprevious name of the Division of Health Benefits (DHB). These denials are then re-adjudicated by Vaya without action required from the provider. pgESm\pbEYAw]k7xVv]8S>{E}V%(d NCTracks staff from provider enrollment, provider relations, claims, and prior approval will be available to assist NC providers with questions or concerns regarding NCTracks. 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. The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. There are several types of TINs that vary according to taxpayer category. Side Nav. 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). Key milestone dates, where to turn for help, Provider Playbook, PHP quick reference guides, webinars, Provider Directory, Help Center and Provider Ombudsman. 1 0 obj NCTracks - FY 2022 Documents NCTracks - FY 2022 Documents. Automated Voice Response System. read on Provider Re-credentialing/Re-verification, Provider Re-credentialing/Re-verification, North Carolina Department of Health and Human Services. denial. D19: Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/01/1995 | Stop: 06/30/2007 The ordering provider is responsible for obtaining PA; however, any provider can request PA when necessary. NCTracks Call Center: 800-688-6696 Call the health plan for coverage, benefits and payment questions. Claims adjudicated for providers who do not have valid EFT information on file will suspend for 45 days awaiting an EFT update, after which they will deny. %PDF-1.6 % Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim. 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. Services must be performed and billed by the rendering provider. Does the modifier on the PA match the modifier assigned to your agency in NCTracks? endobj However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. endstream endobj 206 0 obj <. For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page. 4 0 obj 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. A submitted claim that has either been paid or denied by the NCTrackssystem. endobj 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). 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. For more information, see the NC DMH/DD/SAS website. endobj Check NCTracks for the Beneficiary's enrollment (Standard Plan or NC Medicaid Direct) and health plan. 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. Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks. This status indicates that your Prior Approval (PA) is new and being reviewed by a clinical specialist for a decision. Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code. 2001 Mail Service Center <>/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>> A claim transaction that changes the payment amount and/or units of service of a previously paid claim. EFT information may be updated by authorized provider personnel using the secure. NCTracks Contact Center For claims and recoupment please contact NC Tracks at 800-688-6696. m7lcD13r}y`z7l^x{p-R4%S,nM[VHD8- tu^9|NGjQ\#hQ#iJDnrkv. Usage: This code requires use of an Entity Code. DHB includes Medicaid. endobj Previously Denied Billing Codes for NP, PA and Certified Nurse Midwives. The ordering provider is responsible for obtaining PA; however, any provider . American Dental Association. Providers needing additional assistance with updating the information on their NCTracks provider record may contact the NCTracks Contact Center at 800-688-6696. 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. Payment from NCTracks to providers is made through EFT. 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 Ombudsman will also investigate and address complaints of alleged maladministration or violations of rights against the health plans. A claim in this state is said to be "pended.". Secure websites use HTTPS certificates. hbbd```b``3@$Sd9 "`m An official website of the State of North Carolina, Occupations regulated by North Carolina require licensure, Health care facilities in North Carolina must be licensed, Review updated inspection reports, facility rating and penalties, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing. 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. For more information, see the NCDPHwebsite. If contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve. It could also be that this provider is requiring a legacy ID. Additional benefits include enhanced behavioral health services, Early Periodic Screening, Diagnosis and Treatment (EPSDT) services and non-emergency medical transportation (NEMT). Medicaid reviews requests according to the clinical coverage policy for the requested service, procedure or product. Secure websites use HTTPS certificates. Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code. A. Ensure beneficiary eligibility on the date of service, Guarantee that a post-payment review that verifies a service medically necessary will not be conducted. Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. This table of codes are the allowable POS for billing G9919. If active, this is the taxonomy that should be used on claims. The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. Customer Service Agents are available to answer questions at this toll-free number:Phone: 800-688-6696. Have you already billed for all approved hours this month? A. xmo6wR|T+27b/4[q4R&i)w'IHe/hw$0]fG'8X,],L}w}{H 'p1 llv>l+M-:>`.C$p}9rLUxi>-f g2d-4`lt KvpnY8A>J&U[**xXCeh}UZ>HF Previously referred to as the Medicaid ID. Providers can access the AVRS by dialing 1-800-723-4337. 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. A. NC Medicaid Managed Care Billing Guidance to Health Plans. 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. 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 Year-to-Date. PROVIDERS - Click on the Providers tab above to enter the Provider Portal. The NCTracks AVRS provides information on recipient eligibility, claim status inquiry, checkwrite amount, and prior approval for the Division of Public Health. endobj This status indicates your Prior Approval (PA) is still under review. The PHP quick reference guides are available on the Provider Playbook Fact Sheet webpage under the Health Plan Resources section. <> Third Party Liability. NCTracks is the multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services. Customer Service Center:1-800-662-7030 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.