General FAQs

NCTracks is used by the Division of Health Benefits (DHB); the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS); and the Division of Public Health (DPH).

Providers enrolled in DHB, DMH/DD/SAS and DPH health plans submit claims for payment of covered health care services through the NCTracks Provider Portal. NCTracks coordinates processing among the payers to ensure the proper assignment of the payer, benefit plan and pricing methodology for each service on a claim. NCTracks processes health care claims for about 70,000 enrolled DHHS providers who serve over 1 million North Carolina citizens.

Providers who are contracted by Local Management Entities (LMEs) to enroll and perform state funded DMH/DD/SAS services submit their claims to the LME.

Providers and recipients of services from the Division of Mental Health/Developmental Disabilities/Substance Abuse Services should contact their LME/MCO to obtain information regarding eligibility, claims status and payment, etc.

The NCTracks Provider Portal provides a secure and convenient method to complete and submit initial provider enrollment applications.

Providers have the ability to complete the application online and to electronically sign and submit the application through the web. The electronic enrollment process also includes the option to upload supporting documents with the initial application.
 

The NCTracks Provider Portal has been carefully designed with ease of use and productivity in mind. Some of the key features available are:
• The ability to receive announcements related to key program or process changes
• Receipt of personalized messages in a secure mailbox
• Enhanced functionality that allows providers to manage changes, update provider records, add services to a location, participate in electronic communications and RSS news feeds, as well as manage affiliations to billers, groups and organizations.
• Automation of the prior authorization process
• Recipient eligibility verification
• Checkwrite information
• Remittance Advices on-line
 

The secure NCTracks portal can be accessed using the statewide universal North Carolina Identity (NCID) Management-issued user ID and password.

The North Carolina Identity (NCID) Management Service is the standard identity management and access service provided to state, local, business and citizen users by the Office of Information Technology Services. NCID enables its customers to achieve an elevated degree of security and access control to real-time resources such as customer based applications and information retrievals.

Enterprise features of the NCID Service provide for an efficient and effective means for securing access to online services. Customers can leverage the service to:
• Verify the identity of individual users
• Manage user accounts
• Assign appropriate access to online resources
• Delegate authority or distribute administrative tasks
• Automate certain key functions

NCTracks uses the NCID services to enable the State’s Medicaid Management Information System solution with a single sign-on methodology. More NCID specific information and FAQ’s about NCID are located at https://www.ncid.its.state.nc.us/.
 

All staff who are provisioned to access a provider's record, training or have view or update rights to the provider record to include claims and prior approvals in the NCTracks Provider Portal will need to acquire their own North Carolina Identity (NCID) Management-issued user ID and password.

 

You will need to assign an Office Administrator and a backup staff person (User Administrator) who will be responsible for staff account assignment and identification of roles. This can be done through our self-service, user administration feature on the NCTracks Provider Portal.

Our fiscal agent, CSRA, has trained staff in their provider call center and technical help desk to resolve issues. The hours of availability are:
General:
Monday through Friday: 8:00 a.m. to 5:00 p.m.

Pharmacy Prior Approval:
Monday through Friday: 7:00 a.m. to 11:00 p.m.
Saturday and Sunday: 7:00 a.m. to 6:00 p.m.

Non Pharmacy Prior Approval:
Monday through Friday: 7:00 a.m. to 7:00 p.m.
Saturday and Sunday: 8:00 a.m. to 5:00 p.m.
 

Providers can access electronic views of their RA via the secure NCTracks Provider Portal. Providers will also be able to inquire online regarding payment status from multiple payers (DHB and DPH).

For DMH/DD/SAS providers, only the Local Management Entities (LMEs) have access to the NCTracks Provider Portal.
 

There is a separate section for Carolina ACCESS management fees that includes:
• Dates of service
• Rate cohort code and description
• Paid amount
• Number of claims
 

There is a separate section for Health Check fees that includes:
• Dates of service
• Rate cohort code and description
• Paid amount
• Number of claims
 

Yes. The EOBs used to report the disposition of the claims at the detail level are the same ones that appear on the EOB summary page. The EOB summary page is the last page in the RA and lists EOB codes and definitions for all EOBs reported in the RA.

Yes.

If at least one of the detailed lines is paid, the claim header status would reflect the paid status. However, all the detail lines are reported on the RA. The submitted charges on the denied line items are reported but the reimbursement amount will be zero. Also, each line item will have the EOB, edit, and HIPAA error codes that explain why the claim detail item was denied. Non-covered charges are also reflected at the detail level and a total is also provided.

Yes. Line item details are reported on the RA by service dates.

Pended claims are reported separately in the Pend Claims Remittance section of the RA.
 

Each edit in the new system will map to only one EOB. The EOBs can be mapped to the HIPAA remark codes. There is not, however, a 1-to-1 relationship between HIPAA remark codes and EOBs.

Yes. You can submit an adjustment through the NCTracks Provider Portal or via an 837 batch file. For DMH/DD/SAS providers, only the Local Management Entities (LMEs) will have access to adjust claims on-line.

Yes. Providers can create and submit most PA requests with attachments as electronic documents, as required, via the NCTracks Provider Portal. Providers also have the ability to determine if a specific service or procedure requires prior approval.

For DMH/DD/SAS providers, only the Local Management Entities (LMEs) can submit prior authorizations online.
 

For dates of service prior to November 1, 2016, providers have up to six months from the date of service to request a CCNC/CA override via NCTracks web portal, telephone, or fax.  Effective with dates of service November 1, 2016, providers shall not request CCNC/CA overrides.

Providers can inquire on a prior approval or a Managed Care override request via the NCTracks Provider Portal regardless of how the request was submitted.

 

Once a decision is reached on a prior approval request, an e-mail will be sent to the provider at the office e-mail address provided. Many types of prior approval requests, particularly pharmacy requests, can be immediately approved by the NCTracks system. This means that the provider will receive an immediate approval when a request is received by phone or via the NCTracks Provider Portal.

 

DMH/DD/SAS providers must contact the Local Management Entities (LMEs) for prior approval requests.
 

The PA confirmation number is the number that providers receive to indicate that a prior approval request was successfully submitted to NCTracks. This number is used to inquire on the status of a request via the NCTracks Provider Portal, or when calling fiscal agent staff to discuss a request.

Effective with dates of service November 1, 2016, providers shall not use the NCTracks provider portal to enter or inquire about a CCNC/CA referral.  This online functionality will not be available effective May 1, 2017.
 

Yes. Providers can check the status of a Managed Care referral via the NCTracks Provider Portal.

DMH/DD/SAS providers must check with their Local Management Entities (LMEs) on the status of referrals.
 

Go to www.CSRA.com and click on Careers.