Reminder - Default Effective Dates When Updating Provider Record

When updating a provider record in NCTracks, the Manage Change Request (MCR) will assign a default effective date of the current date to most changes. The same is true of initial enrollment applications. This is important because the system will edit subsequent transactions against the effective dates in the provider record. For example, claims are edited against the effective date of the taxonomy codes on the provider record. If a provider bills for a service rendered prior to the effective date of the relevant taxonomy code on the provider record, the claim will deny.

Some effective dates can be changed from the default date. The effective dates when you add/reinstate a health plan, service location, or taxonomy code can be changed from the default date. However, the effective date must be changed before the initial enrollment application or MCR is submitted. (The effective date also cannot precede the enrollment date or the date associated with the relevant credential or license, and it cannot be older than 365 days.)

Other effective dates cannot be changed from the default date. For example, the effective date for affiliation of an individual provider to a group or hospital will default to the current date and it cannot be changed. Therefore, it is important that affiliations be designated on the provider record prior to rendering the service. [Note: the affiliation edit is currently set to pay and report, but at some point the State will likely change the disposition of this edit to deny.]

NOTE: The State must approve retroactive effective dates. Providers are not guaranteed a retroactive effective date and are strongly encouraged to provide services only after they are enrolled as an N.C. Medicaid or N.C. Health Choice (NCHC) provider. However, DMA will consider specific requests for retroactive effective dates if a beneficiary has been granted retroactive eligibility, an emergency service was provided, or medically necessary services were rendered and the provider's credentials, licensure, certifications, etc. were active and in good standing for the earliest effective date of service.

If an initial enrollment application or a Manage Change Request is submitted with the wrong effective date(s), the provider will need to contact the NCTracks Call Center at 1-800-688-6696 and request a ticket be entered to change the effective date. This process may take several weeks to complete because it requires multiple levels of approval. Consequently, providers are encouraged to verify the effective dates of any additions or changes to the provider record prior to submitting the initial enrollment application or MCR.