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. Ensure beneficiary eligibility on the date of service, Guarantee that a post-payment review that verifies a service medically necessary will not be conducted. <>/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 lock icon or https:// means youve safely connected to the official website. DHB includes Medicaid. The person receiving services from a provider. Type a topic or key words into the search bar, Select a topic from the available list of Categories. <>>> stream Entity's National Provider Identifier (NPI). m7lcD13r}y`z7l^x{p-R4%S,nM[VHD8- tu^9|NGjQ\#hQ#iJDnrkv. (claim numbers), denial codes, etc., the more help the NCTracks team will . For more information, see the NC DHBwebsite. 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. Are you billing within the approved effective dates. Medicaid reviews requests according to the clinical coverage policy for the requested service, procedure or product. A Remittance Advice is generated during each checkwrite cycle for every NPI. 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. A lock icon or https:// means youve safely connected to the official website. Infant-Toddler Program of the NC Division of Public Health, Local Management Entity responsible for behavioral health providers. Customer Service Center:1-800-662-7030 Prior Authorization)- For more information regarding Prior Approval and NCTracks, see the Prior Approval webpage on the Provider Portal. However, providers can also submit paper forms via mail or fax. A. An official website of the State of North Carolina, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). 10 0 obj A submitted claim that has either been paid or denied by the NCTrackssystem. % For billing information specific to a program or service, refer to theClinical Coverage Policies. 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. NCTracks staff from provider enrollment, provider relations, claims, and prior approval will be available to assist NC providers with questions or concerns regarding NCTracks. Providers who use NCTracks are required to have an NPI. Customer Service Center:1-800-662-7030 (Also known as Beneficiary.). Check NCTracks for the Beneficiary's enrollment (Standard Plan or NC Medicaid Direct) and health plan. If contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve. Division of Public Health. Documents. American Bankers Association. Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal. To Get A National Provider Identifier (NPI): Did you complete a service plan for the most current assessment for the beneficiary? D18: Claim/Service has missing diagnosis information. Place of Service Indicator Codes Updated Some claims have also denied for Place of Service (POS) mismatch. Below are some of the sessions most helpful for Managed Care launch. Secure websites use HTTPS certificates. FY22_DMH Budget Criteria.xlsx. 7 0 obj Services must be performed and billed by the rendering provider. NCTracks uses the ADA Form for dental prior approval and claim submission. Secure websites use HTTPS certificates. The system-assigned number used to track a claim throughout the processing steps in NCTracks. A wide variety of topics have been covered with sessions including an open question and answer period. For claims and recoupment please contact NC Tracks at 800-688-6696. endobj &Vy,2*@q?r 6y@$Y 9 $309}0 b Primary care case management program through the networks of Community Care of North Carolina. endobj ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are required to use ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2015. Providers needing additional assistance with updating the information on their NCTracks provider record may contact the NCTracks Contact Center at 800-688-6696. For prescription drugs requiring PA, a decision will be made within 24 hours of receipt of the request. A. EFT information may be updated by authorized provider personnel using the secure. Office Administrator - The owner or managing employee of a provider organization responsible for maintainingthe provider record. NCTracks uses the ANSIASC X12 standards, which includes transations for claim submission, eligibility verification, and remittance advice, among others. Prior approval is issued to the ordering and the rendering providers. DHB includes Medicaid. Have you already billed for all approved hours this month? Services must be provided according to state and federal statutes, rules governing the NC Medicaid Program, state licensure and federal certification requirements, and any other applicable federal and state statutes and rules. Secure websites use HTTPS certificates. TheNC Medicaid Help Centeris an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. The standard for initial filing of claims is up to 12 months from thedate of service. % Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. For more information, see the Trading Partner Information webpage on the Provider Portal. 6pRBu5U/rtCk$]TNBrFhL\ssmUFMWAtp $#b;;`3.b(fi^z:h;/\QOS\f3:L NZN%[HEqYFKD e{k1Sq!uH.v;4fM 8D ` x?/ Follow these easy steps to begin using the new system. 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. The provider must use the taxonomy approved on their NC Medicaid provider record. 12 0 obj 242 0 obj <>stream 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). Year-to-Date. Federal regulations that govern the Medicare program under Title XVIII (18)of the Social Security Act. A payment received from a Medicaid provider due to an erroneous payment. Additional benefits include enhanced behavioral health services, Early Periodic Screening, Diagnosis and Treatment (EPSDT) services and non-emergency medical transportation (NEMT). FY22 DMH BP Hierarchy. The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. 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. Notes: Use code 16 with appropriate claim payment remark code. %PDF-1.6 % NCTracks is updating the claims processing system as inappropriately denied codes are received. A claim transaction that changes the payment amount and/or units of service of a previously paid claim. Health plans are expected to resolve complaints promptly and furnish a summary of final resolution to NC Medicaid. If active, this is the taxonomy that should be used on claims. <> x[oInCkzf$3v| *\H#W=/n+k _nyZ}j>~d_-|]_=7/frxzz\F#6M//x/qfI[_^{,// e)[>]^3T=g-csx?//El~7eWNKxvOXFJM[n*L%Q3 DaL[~\ 230 0 obj <>/Filter/FlateDecode/ID[<086C1C0E7BC6F44BB21D296DD5BDE030><5EA9E2A6EA895E4CB3D6CBE5CA4E80B9>]/Index[205 38]/Info 204 0 R/Length 121/Prev 314253/Root 206 0 R/Size 243/Type/XRef/W[1 3 1]>>stream For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page. For questions related to your NCTracks provider information, please contact the NCTracks Call Center at 800-688-6696. NCTracks - FY 2022 Documents NCTracks - FY 2022 Documents. Transition of Care for beneficiaries receiving long-term services and supportsAn overview ofhow NC Medicaid Managed Care impactsbeneficiaries with disabilities and older adults who are receiving Long-Term Services and Supports (LTSS). PROVIDERS - Click on the Providers tab above to enter the Provider Portal. Once a complete request has been submitted, Medicaid may: Medicaid notifies the provider following established procedures of approvals, including service, number of visits, units, hours or frequency. An official website of the State of North Carolina, Occupations regulated by North Carolina require licensure, Health care facilities in North Carolina must be licensed, Review updated inspection reports, facility rating and penalties, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing. <> hbbd```b``3@$Sd9 "`m Claims submitted for prior-approved services rendered and billed by a different provider will be denied. The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement. <> It is one of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. To learn more, view our full privacy policy. Does your beneficiary have active Medicaid? Department of Health and Human Services. If the beneficiary has a current appeal in QiReport, Liberty can answer questions regarding appeals. 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. Claims specialists may contact providers to alert them of any other denials the provider needs to correct and resubmit. 13 0 obj A lock icon or https:// means youve safely connected to the official website. What error codes need to be handled by NC Tracks? State Government websites value user privacy. They include the Social Security Number (SSN) and Employee Identification Number (EIN). FY22_DMH DX Code Array.xlsx. 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. . This is a glossary of frequently used acronyms and terms associated with NCTracks. Federal regulations that govern the Medicaid program under Title XIX (19) of the Social Security Act. 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: A. For more information, see the NCDPHwebsite. Contact NC Medicaid Contact Center, 888-245-0179 Related Topics: Bulletins All Providers Medicaid Managed Care denial. 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. 132 - Entity's Medicaid provider id. Every NPI must have an OA, but a single OA may be responsible for multiple NPIs. endobj Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. 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. The Ombudsman service is separate and apart from the Health Plan Provider Grievances and Appeals process. This service is intended to represent the interests of the provider community, provide supportive resources and assist with issues through resolution. The ordering provider is responsible for obtaining PA; however, any provider . The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. A. 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? Office of Rural Health and Community Care. 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. It could also be that this provider is requiring a legacy ID. Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. May be done automatically as part of claims reprocessing. <> For more information, see the NC DMH/DD/SAS website. The date that the request is submitted affects payment authorization for services that are denied, reduced or terminated. 14 0 obj There are several types of TINs that vary according to taxpayer category. This status indicates that your Prior Approval (PA) is new and being reviewed by a clinical specialist for a decision. Division of Health Benefits (new name for the Division of Medical Assistance or DMA). ",#(7),01444'9=82. AmeriHealth Caritas: 888-738-0004 Carolina Complete: 833-522-3876 Healthy Blue: 844-594-5072 United Healthcare: 800-638-3302 Listed below are the most common error codes not handled by Liberty Healthcare of NC. DHHS currently has eight LME-MCOs operating under the 1915 b/c Waiver. 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. It has three separate portals for specific internet access to different sectors of the business: Providers, Recipients and internal operations needs. To learn more, view our full privacy policy. For more information on PA status codes, see the Prior Approval FAQs. Third Party Liability. Raleigh, NC 27699-2000. 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. Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code. A beneficiary must be eligible for Medicaid coverage on the date the service or procedure is rendered. D19: Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/01/1995 | Stop: 06/30/2007 For more information, see the NCDHHSwebsite. 1 0 obj endobj Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. To learn more, view our full privacy policy. Links to the Health Plan training webpages have also been added on the Provider Playbook Training Courses webpage. <> Electronic Data Interchange refers to the electronc exchange of information between computer systems using a standard format. endobj When a change in authorized service level goes into effect, the old authorization will end and the new authorization will begin. 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. The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. For more information on PA status codes, see the Prior Approval FAQs. This allows a claim to be corrected and processed without being resubmitted. The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. This status indicates your Prior Approval (PA) is still under review. The Provider Ombudsman contact information can be found in each health plans Provider Manual linked on the Health Plan Contacts and Resources Page. 2001 Mail Service Center 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). 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. Other insurance companies responsible for medical coverage; their claims must process and pay or deny before State processing. 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 the typical initial state of a PArequest thathas been submitted to NCTracks. NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). It has three separate portals for specific internet access to different sectors of the business: Providers, Recipients and internal operations needs. %%EOF For claims and recoupment please contact NC Tracks at 800-688-6696. Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. 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. This edit will be applied when the billing provider taxonomy code submitted on a PROFESSIONAL claim is any of the below: 251E00000X, 251G00000X, 261QE0700X, 275N00000X, 282N00000X, 282NC0060X, 283Q00000X, 284300000X, 311ZA0620X, 313M00000X, 314000000X, 315P00000X, 320800000X or 323P00000X. Reversal of a paid claim, either at the provider's request or as part of an automated recoupment. 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 State Government websites value user privacy. Interim reports are temporarily available on the Managed Care Provider PlaybookTrending Topicspage to assist providers in verifying their records. FY22_DMH BP Eligibility Criteria.pdf. 2 0 obj Prior Approval (a.k.a. Payment from NCTracks to providers is made through EFT. 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. 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. June 17, 2021 | Hot Topics with health plan Chief Medical Officers. All services provided on or after January 1, 2013 must be billed using the new PCS codes. Customer Service Agents are available to answer questions at this toll-free number:Phone: 800-688-6696.
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