NCTracks Recap of Coming Attractions on October 29

This is a recap of all the NCTracks changes that will be occurring the weekend of October 29, 2017, as communicated previously in separate emails and posted on the NCTracks provider portal. Providers are encouraged to review this important information. Training will be available for many of these changes. Click on the link in each summary below to review the full communications.

 

Abbreviated Application for Ordering, Prescribing and Referring Practitioners

A new abbreviated enrollment application will be available for ordering, prescribing, and/or referring (OPR) practitioners who order or refer items or services for recipients, but do not submit claims to North Carolina Medicaid and N.C. Health Choice (NCHC) programs. In addition, starting November 1, 2017, Residents and Interns licensed through the N.C. Medical Board with a resident in training license (RTL) will be able to enroll as OPR lite providers via the abbreviated application. For additional information on OPR lite enrollment, refer to Abbreviated Application for Ordering, Prescribing and Referring Practitioners.

 

Claims Pended for Incorrect Billing Location

The NC Department of Health and Human Services (DHHS) will implement in NCTracks the validation of the billing provider address submitted on the claim to the location listed on the provider record for the date(s) of service submitted. If NCTracks cannot match the billing provider's address to an active service location in the NCTracks provider's file, the claim will be pended for 60 days to give the billing provider time to add or correct the address. For information on how to resolve the pended claims, refer to Claims Pended for Incorrect Billing Location.

 

Maintain Provider Eligibility Process

N.C. DHHS will also implement in NCTracks a quarterly Maintain Eligibility Process. This process identifies enrolled providers with no claim activity within the past 12 months. NCTracks will notify the provider by a Notification of Inactivity Letter posted to the secure provider portal mailbox. The provider must attest electronically to remain active. For additional guidance, refer to Maintain Provider Eligibility Process.

 

Out-of-State Provider Enrollment

Out of state (OOS) providers seeking to enroll with N.C. Medicaid or N.C. Health Choice will have the option to use a full-enrollment application or an abbreviated lite-enrollment application. Requirements vary based on the type of enrollment. Refer to Out-of-State Provider Enrollment for additional information.

 

Medicaid Secondary Claims Where Cost Share Does Not Apply, and Contractual Obligations Reporting on Medicaid Secondary Claims

N.C. DHHS will implement in NCTracks new business rules for processing Medicaid secondary claims and claim adjustments where a Third-Party payer made a payment on the claim and Cost Share (Patient Responsibility) was not applicable. Specific coordination of benefit (COB) payer filing indicators will identify Third Party claims that will price without Cost Share. This new method will apply to X12 837 Institutional, Professional, and Dental claim transaction types (837I/P/D) as well as claims keyed into the secure provider portal. For additional information, including a list of the filing indicators, refer to Medicaid Secondary Claims Where Cost Share Does Not Apply, and Contractual Obligations Reporting on Medicaid Secondary Claims.

 

Validation of Prior Approval Requests Submitted via NCTracks Portal

N.C. DHHS will add to NCTracks four new data validations during the entry of prior approval (PA) requests through the secure provider portal. Currently, these data validations are performed after the PA is submitted in NCTracks, which results in the denial or void of a PA record. Adding the validations to PA entry will inform the provider of the issue immediately and not allow a PA record to be submitted that would not be able to be approved. For details on the new data validations, including a list of exceptions, refer to Validation of Prior Approval Requests Submitted via NCTracks Portal.

 

New Features for Voided Prior Approval Requests

A PA request may be voided in NCTracks for several reasons. The reason a PA request was voided will now be available in the details of a PA inquiry performed through the secure provider portal. The void description will help providers understand why the PA request was voided, so they can determine how to proceed. Refer to New Features for Voided Prior Approval Requests for more information.

 

NCTracks Updates for Patient Monthly Liability

N.C. DHHS will update NCTracks to reflect the revisions to the N.C. Medicaid business rules regarding systematic adjustments and patient monthly liability (PML) processing. PML applies to specific types of claims, including inpatient hospital claims, skilled nursing facility claims and hospice claims. For additional guidance, refer to NCTracks Updates for Patient Monthly Liability.

 

Automation of Prior Approval Update with Change of Ownership

When a Change of Ownership (CHOW) occurs and the purchasing provider plans to continue rendering services for which the seller has already received PA, additional steps are required. Because the purchasing provider’s number is not on the seller’s PA, the seller’s PA must be end-dated and a new PA record must be created under the purchasing provider’s number. Historically, the PA update process required by a CHOW was handled as a manual process. NCTracks will automate the end-dating of existing seller PA records and systematically create new PA records under the purchasing provider. For a list of exceptions and additional information, refer to Automation of Prior Approval Update with Change of Ownership.

 

Hospice Payment Reform

N.C. DHHS will implement Hospice Payment Reform in NCTracks based on guidance from the Centers for Medicare & Medicaid Services (CMS). The reform consists of service intensity add-on payments for hospice social worker and registered nurse visits provided during the last seven days of life when provided during routine home care. Payment reform also includes the implementation of two routine home care rates, paying a higher rate in the first 60 days of a hospice election and a lower rate for days 61 and later, based on paid claims history. For more information, including valid discharge codes denoting death of the patient, refer to Hospice Payment Reform.