NCTracks
Coming Soon to NCTracks Changes Impacting CAP/DA Effective November 1, 2019
Attention CAP/DA Providers
Effective Nov. 1, 2019, due to the Home and Community-Based Service updates related to the CAP/DA Waiver Renewal, providers will see changes to enrollment applications when adding CAP Services. The following changes impacting CAP/DA services, including consumer direction services under the waiver, will be implemented in the NCTracks system to match the implementation of the CAP/DA Waiver Renewal:
- Procedure code T2040 will be billable by a maximum of two providers within a month.
- Claims billed with procedure code T2040 will only be reimbursed for a maximum of two separate financial management services (FMS) providers to allow the billing of set-up for a beneficiary to transition from one FMS provider to another within a single calendar month.
- Procedure code T2040 will be billable to a maximum of $93.00 per calendar month, per provider.
- Claims billed under a single provider will be denied if the amount claimed will exceed the monthly total of $93.00 for that beneficiary by that provider.
- Procedure codes T1016 and T2041 will be billable by a maximum of two providers within a month.
- Claims billed with procedure codes T1016 and T2041 will only be reimbursed for a maximum of two separate case management/care advisor (CM/CA) providers to allow the billing of initial case management for a beneficiary to transition from one CM/CA provider to another within a single calendar month.
- Procedure codes T1016 and T2041 will be updated to allow initial and plan of care development CM/CA prior to beneficiaries’ enrollment dates.
- Claims billed with procedure codes T1016 and T2041entered up to 30 calendar days prior to a beneficiary’s enrollment under CAP/DA will not be denied on grounds of enrollment. This allows provider of CM/CA services to provide initial case management and plan of care development assistance to the beneficiary prior to the beneficiary’s enrollment date. These services can only be claimed once the beneficiary has been fully enrolled, but the dates of service of such claims can predate the beneficiary’s enrollment by up to 30 calendar days. Beneficiaries transitioning to the CAP/DA waiver via Money Follows the Person (MFP) will have a similar 60-day calendar lookback to account for case management/care advisory over the lengthy transition process.
- Procedure codes S5125 and S5135 cannot be billed for the same dates of service.
- Claims billed with procedure code S5125 will deny if the beneficiary shows paid claims for S5135 on that same date of service. The same will be true if claims for S5135 are billed for a date of service showing S5125 claims. These two services, S5125 Personal Care Aide and S5135 Personal Care Assistance are similar services utilized by provider-led and consumer direction beneficiaries respectively and cannot be billed for on the same dates of service.
- Claims billed with procedure code S5125 will deny if the beneficiary shows paid claims for S5135 on that same date of service. The same will be true if claims for S5135 are billed for a date of service showing S5125 claims. These two services, S5125 Personal Care Aide and S5135 Personal Care Assistance are similar services utilized by provider-led and consumer direction beneficiaries respectively and cannot be billed for on the same dates of service.