Update to Claims Pended for Incorrect Billing Location –Change in Edit Disposition

Note: This article has been updated since it was originally published on October 18.

Effective October 29, 2017, the N.C. Department of Health and Human Services (DHHS) will validate through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider address, city, state, and zip code (first 5 digits) on all N.C. Medicaid and N.C. Health Choice claims must match exactly with the corresponding information on the provider record. (The match is not case sensitive.)

NOTE:  It was previously announced the claim would pend for 60 days.  The edit will be implemented with a “pay and report” status.  Providers will receive an informational Explanation of Benefits (EOB) 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE. 

NCTracks will use the address submitted on the claim (Loop 2010AA / block 33) to match to a service location address on the provider’s record.  If NCTracks cannot match the billing provider's address to an active service location in the NCTracks provider's file, the provider will receive on the paper Remittance Advice (RA) the informational EOB code 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE. This EOB indicates that the provider should add or correct the billing provider address on the provider’s record in NCTracks or correct the address submitted on the claim.

The edit disposition of pay and report is temporary.  An announcement to providers will be made when the edit disposition will change to pend.  Claims pended with EOB 04529 will automatically recycle daily, so if the provider adds the correct address to the provider record, the claim will resume processing. If the provider does not add the correct address to the provider record within 60 days, the claim will be denied.

Provider records can be updated with a new billing provider address by submitting a Manage Change Request (MCR) in the secure NCTracks provider portal. Alternatively, providers can correct the billing provider’s address on the claim so it matches a service location on the billing provider’s record.

Note: MCRs may be subject to credentialing and verification. For guidance on submitting an MCR, refer to the User Guide, How to Change the Physical Address in NCTracks, in SkillPort.

Claims with dates of service prior to October 29, 2017, will not be subjected to the edit. Pharmacy and crossover claims also will be excluded from the edit.