NCTracks
Attention Hospital and ACA Providers
Over the next several weeks, NCTracks will be reprocessing claims previously adjudicated by HP Enterprise Services (HPES) for Diagnosis-Related Group (DRG) Grouper version 30 and enhanced Affordable Care Act (ACA) payments. Providers who are impacted should expect a larger than normal Remittance Advice (RA) in the upcoming checkwrites.
HOSPITAL PROVIDERS:
NCTracks will be reprocessing inpatient institutional claims adjudicated by HPES with dates of service from October 1, 2012 through June 30, 2013, to apply version 30 of the DRG Grouper. Based on the application of the Grouper, the reimbursement for the reprocessed claims may change. The Explanation of Benefits (EOB) associated with these reprocessed claims will be 06041 - "DRG Grouper Version 30 Adjustments." Hospital providers will see the reprocessed claims in a separate section of the paper RA for the June 3, 2014 checkwrite.
The 835 electronic transactions will include all of the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)
ACA PHYSICIANS:
NCTracks has begun reprocessing physician claims previously adjudicated by HPES from January 1 to June 30, 2013 to incorporate the enhanced ACA payments for attested providers of primary care services. The ACA reprocessing started May 15, 2014 and it is expected to be completed before the last checkwrite of the fiscal year on June 24th. The ACA reprocessing is based on Recipient ID, so it is likely providers will have claims reprocessed over several checkwrites. The EOB associated with these reprocessed claims will be 06040 - "Reprocessed for ACA Adjusted Payment." Providers will see the reprocessed claims in a separate section of the paper Remittance Advice.
The 835 electronic transactions will include all of the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)
NCTracks started ACA reprocessing with 50,000 legacy physician claims to identify and analyze edit differences between HPES adjudication and NCTracks adjudication. There were claims denied for a number of edits and these claims will report on some providers' paper RAs for the May 20th checkwrite. Providers do not need to take any action with these denied claims. These claims will be reprocessed for providers by the June 24th checkwrite.
If providers have any questions about the reprocessed claims, please contact the NCTracks Call Center at 1-800-688-6696 or NCTracksProvider@nctracks.com.