Attention: Medicaid Inpatient Hospital Providers Reprocessing of Inpatient Claims for Groupers 28, 30 & 31

NCTracks reprocessed Medicaid inpatient claims previously paid by Medicaid (NCTracks & HPES) to correctly capture the appropriate DRG Grouper for the dates of service on the claim. The reprocessing occurred on the following checkwrite dates:

• April 8 checkwrite– claims with dates of processing and dates of service between October 1, 2013 and December 31, 2013 (DRG 31)
• April 22 checkwrite– claims with dates of processing between July 1, 2013 and November 10, 2013 and dates of service between July 1, 2013 and September 30, 2013 (DRG 30)
• May 28 & June 24 checkwrites – claims with dates of processing and dates of service between October 1, 2012 and June 30, 2013 (DRG 30)

Providers reported that the recoup transactions did not mirror the originally paid claim when viewing the individual line items after the room and board line on each specific claim as shown on the electronic 835. Hospitals that posted to their patient accounts the transaction as shown on the electronic 835 created credit balances on the individual patient accounts that were incorrect. The NCTracks team conducted a review to determine what caused this issue.

When NCTracks processed these claims and the claim was repaid, the CAS segment for some individual line items was not closed at the end of each claim. In some cases, the next claim had a repeat of the CAS segment from the previous claim. Not all claims had this issue for the individual lines below the room and board line, which is the patient line for inpatient claims.

In the review, it was determined that the Medicaid claim history is correct and the paper remittance advice (RA) is correct. The paper remittance can be used to correct the patient accounts. There are no plans to regenerate the 835s.

The issue was resolved as of June 28, 2014.