Medicaid Resolution Inquiry Form No Longer Required for Time Limit Overrides

Effective February 5, 2017, the Medicaid Resolution Inquiry Form will no longer be required if the claim requiring the time limit override is submitted electronically through the NCTracks Provider Portal or through a batch X12 transaction. Providers are encouraged to use this new method, because the Medicaid Resolution Inquiry Form will eventually be phased out.

To provide the required documentation for a time limit override through the NCTracks Provider Portal, follow these steps:

1. Enter the claim electronically through the NCTracks Provider Portal.
2. Include the "Delay Reason Code (DRC)" in the "Additional Claims Information" section.

-Third Party Processing Delay (#7)

-Original claims rejected or denied due to a reason unrelated to the billing limitation rules (#9)

3. The Explanation of Benefits/Remittance Advice must be attached to the claim.
4. The Attachment Type 'EB' must be used to identify the attachment as an explanation of benefits or a remittance advice.
5. Upload the proof of timely filing documentation. If you are unable to electronically upload the documentation, print out the cover sheet that will be used to connect your documentation to your request. Mail the printed cover sheet and corresponding documentation to the PO Box address noted on the cover sheet.

Note: Each submission requires a DRC code, the EB Attachment Type, and copies of documentation (explanation of benefits, vouchers and attachments). Since these documents are scanned, attach only single-sided documents to the inquiry. Do not attach double-sided documents to the inquiry.

Claims submitted with a "Delay Reason Code 7 or 9" and an "Attachment Type EB" will pend for manual review and will be noted with new Explanation of Benefits Code:

EOB 05102 - MANUAL REVIEW OF ATTACHED DOCUMENTATION FOR TIMELY FILING
If the claim submitted does not have documentation with proof of timely filing, the claim will pend for 30 days. If no documentation is received after 30 days, the claim will deny.  

The implementation of this new process in NCTracks will include a new Explanation of Benefits Code:

  • EOB 05103 - OVERRIDE REQUEST FOR TIMELY FILING IS MISSING DOCUMENTATION

Please refer to the Job Aids below (coming soon), located on the Provider User Guides and Training page, for assistance on the time limit override criteria and process.

  • How to Add an Attachment to a Claim
  • Provider Adjustment, Time limit & Medicare Override Job Aid

Please note that the Provider Adjustment, Time Limit & Medicare Override Job Aid is forthcoming.