Attention: All Providers Reminder of QMB Claim Reprocessing

This is a reminder that QMB claims are being reprocessed and will appear in the September 20 checkwrite (tomorrow).

This is an update to a June 2016 Special Medicaid Bulletin on Reprocessing of Crossover Claims for Services Rendered to Qualified Medicare Beneficiaries. The N.C. Division of Medical Assistance (DMA) began the reprocessing of QMB claims with the June 21, 2016, checkwrite. During the month of July, DMA did not reprocess any QMB claims.

The reprocessing of QMB claims resumed with the August 16, 2016, checkwrite, and continues with the September 20, 2016, checkwrite.

Additional details regarding QMB claim reprocessing can be found in the June 2016 Special Medicaid Bulletin. (See link below.)

Note that reprocessing of claims may result in a recoupment. If there are insufficient funds in the current checkwrite to fully satisfy the recoupment, an Accounts Receivable (AR) will be created. Affected providers will receive a First Demand Letter when the AR is created. Recoupment of the AR will begin with the subsequent NCTracks checkwrite. If funds are insufficient to completely collect the amount due from the NPI for which the AR was generated, NCTracks will automatically seek to recoup the AR from other NPIs with the same Internal Revenue Service (IRS) Taxpayer Identification Number (TIN). For more information about the Accounts Receivable process, refer to the February 29, 2016, announcement. (See link below)