Issue with CDSA Claims Being Voided or Recouped

It has been brought to the attention of NCTracks that some providers are experiencing issues with Children’s Developmental Services Agencies (CDSA) services that have been previously paid with the TL procedure code modifier being retroactively voided or recouped incorrectly. The claims are being voided with Explanation of Benefits (EOB) 06125 - CLAIM RECOUPED. CLAIM COVERED BY PREPAID HEALTH PLAN (PHP). 

The services are payable under NC Medicaid Direct (through NC TRACKS) under the current Managed Care Carve Out rules and should be exempt from the retroactive void process; see the June 29, 2021 Medicaid Bulletin for additional information. NC Medicaid is aware of this issue and is currently working with NCTracks on a solution. Updates will be provided as available.