New Provider Portal Inquiries for Dental, Optical, DME/O&P, and Physician Fluoride Varnish Benefit Limits

Enhanced functionality is coming to NCTracks, which will allow N.C. Medicaid and North Carolina Health Choice (NCHC) providers to inquire on additional services/procedures that are subject to benefit limits. Currently, providers can inquire if a recipient is eligible for refraction confirmation and obtain the last service date for certain dental procedure codes. On February 5, 2017, providers will also be able to use the portal to:

  • Inquire on additional dental services, including dental prophylaxis and topical fluoride treatment, periodontal and orthodontic services
  • Receive additional information with refraction confirmation inquiry
  • Inquire on durable medical equipment (DME) and orthotic/prosthetic (O&P) services
  • Inquire on eyeglasses
  • Inquire on physician fluoride varnish services

This functionality will allow providers to determine whether or not the recipient has reached their benefit limits prior to rendering the service. The provider inquiry web page for dental, DME/O&P, and physician fluoride varnish will display claim history by HCPCS or CPT procedure code, recipient ID, and date of service. There will be a ‘Search By Similar’ option on the DME/O&P Service History Page to include claim history for related codes. Eyeglass inquiry is against prior approval (PA) records and will display the last date of approved complete eyeglasses.

Information regarding these services is provided for informational purposes only and is not a guarantee of payment. Payment for services is subject to criteria and limitations documented in N.C. Medicaid and Health Choice clinical coverage policies.

As with the current benefit limit inquiries, this new functionality will be available through the Prior Approval drop down menu on the secure NCTracks Provider Portal. Access to the secure provider portal requires a login from North Carolina Identity (NCID) Services. Providers or staff who do not have an NCID to access the NCTracks secure provider portal should contact the Office Administrator for their NPI.

New Instructor-Led Training (ILT) and Computer-Based Training (CBT) courses and a Job Aid are being developed to assist providers with using the new benefit limit functionality. The courses and Job Aid will be in SkillPort, accessible through the Provider Training button on the secure provider portal. (Existing training material referencing benefit limit inquiries will also be updated.) A follow-up announcement will be posted when the training resources are available.