Attention: Providers Clarification on Patient Monthly Liability Discrepancies

Patient Monthly Liability (PML) is the amount the beneficiary is responsible for toward their monthly cost of long term care. Upon determination of Medicaid eligibility for long term care services by the county Department of Social Services (DSS), the Medicaid provider will receive notification of the applicant or beneficiary’s PML. The DMA-5016 Notification of Eligibility for Medicaid/Amount and Effective Date of Patient’s Liability is used to notify providers of the PML amount and any changes to the PML amount. Providers are required to retain the DMA-5016 for audit purposes. The dates and the amounts on the DMA-5016 must match the information on the beneficiary’s eligibility detail in NCTracks. If the dates and the amounts do not match, the provider must contact the county DSS that sent the DMA-5016 for corrections.

Providers may experience discrepancies with the beneficiary’s current eligibility which prevents them from billing for long term care services. The discrepancies may include but are not limited to:

• No patient monthly liability listed on the beneficiary’s file in NCTracks
   
• No DMA-5016 received by the provider
   
• Dates or amounts listed on the DMA-5016 do not align with the dates or amounts on the beneficiary’s eligibility detail in NCTracks

Providers experiencing any discrepancies must contact the DSS in the beneficiary’s county of residence to have the information corrected.

Those with questions about PML should contact the N.C. Medicaid Contact Center at 1-888-245-0179.

Providers experiencing billing issues not related to the DMA-5016 and PML amount should contact NCTracks at 1-800-688-6696.

Recipient Services

DMA, 919-813-5340