NC Department of Health and Human Services NCTracks Call Center: 800-688-6696 Call the health plan for coverage, benefits and payment questions. Links to the Health Plan training webpages have also been added on the Provider Playbook Training Courses webpage. Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks. Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. 3 0 obj A. endobj 1 0 obj The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. For more information, see the NC DMH/DD/SAS website. NCTracks staff from provider enrollment, provider relations, claims, and prior approval will be available to assist NC providers with questions or concerns regarding NCTracks. Interim reports are temporarily available on the Managed Care Provider PlaybookTrending Topicspage to assist providers in verifying their records. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. NC Department of Health and Human Services Medicaid researches requests to determine the effectiveness of the requested service, procedure or product to determine if the requested service is safe, generally recognized as an accepted method of medical practice or treatment, or experimental/investigational. % Customer Service Center:1-800-662-7030 For more information, see CCNC/CA, Protected Health Information - information about health status, provision of health care, or payment for health care that can be linked to a specific individual. Remittance Advice. The National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). Primary care case management program through the networks of Community Care of North Carolina. Beneficiaries who submit an appeal (a request for hearing) within 30 days of the date on the authorization letter are entitled to continue to receive services at the previous level (that was provided before the decision letter was sent, and not to exceed 80 hours per month) while the appeal is pending. . 2001 Mail Service Center This edit will be applied when the billing provider taxonomy code submitted on a PROFESSIONAL claim is any of the below: 251E00000X, 251G00000X, 261QE0700X, 275N00000X, 282N00000X, 282NC0060X, 283Q00000X, 284300000X, 311ZA0620X, 313M00000X, 314000000X, 315P00000X, 320800000X or 323P00000X. 2455. <>>> A. The identification number assigned to a recipient of services from one or more Divisions of the N.C. Department of Health and Human Services (NCDHHS). A Taxpayer Identification Number (TIN) is a number used by the Internal Revenue Service (IRS) to record and track tax payments. Customer Service Center:1-800-662-7030 As of April 1, 2023, all NC Health Choice beneficiaries with active eligibility will be moved to Medicaid, providing them access to Medicaid services that are not currently covered under NC Health Choice. Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. Once children in NC Health Choice are enrolled in Medicaid, they will no longer be subject to cost sharing. 91 Entity not eligible/not approved for dates of service. 13 0 obj Third Party Liability. For further assistance, contact us at claims@vayahealth.comor at 1-800-893-6246, ext. Below are some of the sessions most helpful for Managed Care launch. If the Provider Affiliation information is incorrect, the affiliated individual provider or the Office Administrator for the affiliated individual provider must update the group affiliation. (claim numbers), denial codes, etc., the more help the NCTracks team will . Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. 0 Providers may use the NCTracks managed change request (MCR) process, available in the Secure NCTracks Provider Portal, to modify any provider record or service location information as well as individual to organization affiliations. 1 0 obj Have you already billed for all approved hours this month? Therabill Support Specialist 1 year ago Updated Follow The payer is indicating that either the NPI that you entered for the billing provider or rendering provider is not an NPI that they have on file. Just getting started with NCTracks? <> The ordering provider is responsible for obtaining PA; however, any provider can request PA when necessary. For questions related to your NCTracks provider information, please contact the NCTracks Call Center at 800-688-6696. May refer to Fiscal Year-to-Date (FYTD) or Calendar Year-to-Date (CYTD), Provider Re-credentialing/Re-verification FAQs, Drug Enforcement Administration (DEA) Certification FAQs, Claims Pended for Incorrect Location FAQs, Office Administrator, User Setup & Maintenance FAQs, Ordering, Prescribing, Rendering or Referring Provider (OPR) FAQs, Behavioral Health Provider Enrollment FAQs, Disproportionate Share Hospital Data FAQs, New Medicare Card Project (formerly SSNRI) FAQs, Common Enrollment Application Issues FAQs, Currently Enrolled Provider (CEP) Registration, Provider Re-credentialing/Re-verification, Provider Policies, Manuals, Guidelines and Forms, New Medicare Card Project (formerly SSNRI), https://medicaid.ncdhhs.gov/providers/programs-and-services/community-care-north-carolinacarolina-access-ccncca, website for the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, 40. x[oInCkzf$3v| *\H#W=/n+k _nyZ}j>~d_-|]_=7/frxzz\F#6M//x/qfI[_^{,// e)[>]^3T=g-csx?//El~7eWNKxvOXFJM[n*L%Q3 DaL[~\ NC Medicaid has checkwrites 50 weeks of the calendar year no checkwrites occur the week of June 30 and the week of Christmas. There are several types of TINs that vary according to taxpayer category. AmeriHealth Caritas: 888-738-0004 Carolina Complete: 833-522-3876 Healthy Blue: 844-594-5072 United Healthcare: 800-638-3302 Providers can access the AVRS by dialing 1-800-723-4337. For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page. Although there are many available, the following fact sheets will be most useful for Managed Care go-live and can be found on theFact Sheet page: In addition to the DHHS Combined PHP Quick Reference Guide, NC Medicaids Managed Care Prepaid Health Plans (PHPs) created quick reference guides to include the most current and comprehensive information for providers. Providers must request authorization of a continuing services 10 calendar days before the end of the current authorization period for authorization to continue without interruption for 10 calendar days after the date an adverse decision notice (change notice) is mailed to the Medicaid beneficiary or to the beneficiary's legal guardian and copied to the provider. If the denial results in the rendering provider (or his/her/its agent) choosing . NCTracks is updating the claims processing system as inappropriately denied codes are received. stream Office Administrator - The owner or managing employee of a provider organization responsible for maintainingthe provider record. For prescription drugs requiring PA, a decision will be made within 24 hours of receipt of the request. Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal. <> %PDF-1.5 Once a complete request has been submitted, Medicaid may: Medicaid notifies the provider following established procedures of approvals, including service, number of visits, units, hours or frequency. Usage: This code requires use of an Entity Code. NCTracks AVRS read on Provider User Guides & Training, This section is intended to help NC DHHS providers understand the online Re-credentialing/Re-verification process in NCTracks. FY22_DMH BP Eligibility Criteria.pdf. <> 9 0 obj The provider must use the taxonomy approved on their NC Medicaid provider record. Are you billing within the approved effective dates. State Government websites value user privacy. 10 0 obj pgESm\pbEYAw]k7xVv]8S>{E}V%(d Prior Authorization)- For more information regarding Prior Approval and NCTracks, see the Prior Approval webpage on the Provider Portal. 12 0 obj 7 0 obj Does your beneficiary have active Medicaid? The PCS Provider shall provide a qualified and experienced RN, or other professional as specified in licensure rules to supervise personal care services and write or adjust the new weekly POC so that it can be implemented as soon as the new service level is effective. The Provider Directory Listing Report, as well as the Provider Affiliation Report, is available to all actively enrolled Medicaid and NC Health Choice providers. Federal regulations that govern the Medicare program under Title XVIII (18)of the Social Security Act. If, after using the NC Medicaid Help Center, the inquiry remains unresolved, use the below table to direct the question appropriately: Provider Enrollment inMedicaid or North CarolinaHealth Choice, To update your information, please log intoNCTracks(https://www.nctracks.nc.gov)provider portal to verify your information and submit a MCR or contact the GDIT CallCenter., Health Plans Contact Info here:https://medicaid.ncdhhs.gov/transformation/health-plans/health-plan-contacts-and-resources, Provider to PHP ContractingConcerns or Complaints, Email:Medicaid.ProviderOmbudsman@dhhs.nc.govPhone: 866-304-7062, NCTracksCall Center at 800-688-6696 orlog intoNCTracks(https://www.nctracks.nc.gov [nctracks.nc.gov]) provider portal to update yourinformation, submit a claim, review claims status, request a prior authorization orsubmit a question., Recipient Eligibility, ClaimsProcessing, BillingQuestions, Health Plans Contact Info here:https://medicaid.ncdhhs.gov/transformation/health-plans/health-plan-contacts-and-resources, What does the MedicaidContact Center helpproviders do? Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code. EFT is the electronic exchange of money from one financial institutionaccount to another through computer-based systems. FY22 DMH BP Hierarchy. Visit RelayNCfor information about TTY services. endobj Prior approval is for medical approval only and must be obtained before rendering a service, product or procedure that requires prior approval. For claims and recoupment please contact NC Tracks at 800-688-6696. 230 0 obj <>/Filter/FlateDecode/ID[<086C1C0E7BC6F44BB21D296DD5BDE030><5EA9E2A6EA895E4CB3D6CBE5CA4E80B9>]/Index[205 38]/Info 204 0 R/Length 121/Prev 314253/Root 206 0 R/Size 243/Type/XRef/W[1 3 1]>>stream The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: *PHP may be updating their denial/rejection code description. NCTracks uses the ANSIASC X12 standards, which includes transations for claim submission, eligibility verification, and remittance advice, among others. It will save you valuable time if you verify the following information when encountering issues trying to bill for PCS: Via NCTracks Provider Portal or by calling 1-800-688-6696. NCTracks Contact Center 282N00000X and 3112A0620X). The service must be provided according to service limits specified and for the period documented in the approved request unless a more stringent requirement applies. It has three separate portals for specific internet access to different sectors of the business: Providers, Recipients and internal operations needs. For more information about Carolina ACCESS (CCNC/CA), see the related DHB webpage at https://medicaid.ncdhhs.gov/providers/programs-and-services/community-care-north-carolinacarolina-access-ccncca. Ensure beneficiary eligibility on the date of service, Guarantee that a post-payment review that verifies a service medically necessary will not be conducted. RECIPIENTS - Click on the Recipients tab above to enter the Recipient Portal. endstream endobj startxref Claims submitted for prior-approved services rendered and billed by a different provider will be denied. For more information, see the NC DHBwebsite. A wide variety of topics have been covered with sessions including an open question and answer period. Documents. To learn more, view our full privacy policy. Please refer to checkwrite schedules available on NCTrack's Providers page under Quick Links for cut-off timing for submitted claims. %%EOF The ordering provider is responsible for obtaining PA; however, any provider . It could also be that this provider is requiring a legacy ID. External Code Lists External Code Lists back to code lists Claim Status Codes 508 These codes convey the status of an entire claim or a specific service line. There is an abundance of resources provided by DHHS and the health plans for providers to get help with an issue or for information around a particular question or concern. Raleigh, NC 27699-2000. Infant-Toddler Program of the NC Division of Public Health, Local Management Entity responsible for behavioral health providers. A submitted claim that has either been paid or denied by the NCTrackssystem. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 9 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> NC Medicaid Managed Care Billing Guidance to Health Plans. hb```f``Z {AX,X9pHQuu4~hLGGPd`1@,65A9I:Ac+XDk\X"E]Q|S0`refb`w0)[( , Transition of Care for beneficiaries receiving long-term services and supportsAn overview ofhow NC Medicaid Managed Care impactsbeneficiaries with disabilities and older adults who are receiving Long-Term Services and Supports (LTSS). Please allow 5 business days for Liberty Healthcare to research your request. All billing for dates of service January 1, 2013 and later must be done with the Procedure Code 99509 and one of the following modifiers: A. 2 0 obj Overridesmay begranted and can be requested using theMedicaid Inquiry ResolutionForm under the Provider Forms section of the Provider Policies, Manuals, and Guideline page of the NCTracks Provider Portal. The Medicaid webinars and virtual office hours give providers a chance to hear information and guidance on NC Medicaids transition to Managed Care. NCTracks is the multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services. 14 0 obj A. Medicaid reviews requests according to the clinical coverage policy for the requested service, procedure or product. Automated Voice Response System. A. An official website of the State of North Carolina, NC Medicaid Managed Care Provider Update June 16, 2021, To update your information, please log intoNCTracks(, )provider portal to verify your information and submit a MCR or contact the GDIT CallCenter., https://medicaid.ncdhhs.gov/transformation/health-, NCTracksCall Center at 800-688-6696 orlog intoNCTracks(, https://www.nctracks.nc.gov [nctracks.nc.gov], ) provider portal to update yourinformation, submit a claim, review claims status, request a prior authorization orsubmit a question., dedicated to assisting with inquiries regardingenrollment, claim status, recipient eligibility and other information neededby, Provider Playbook Training Courses webpage, https://www.ncahec.net/medicaid-managed-care, Managed Care Provider PlaybookTrending Topicspage, https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html, Provider Ombudsman: 866-304-7062 (NEW NUMBER) or at, NC Medicaid Ombudsman: 877-201-3750 or at. An official website of the State of North Carolina, Occupations regulated by North Carolina require licensure, Health care facilities in North Carolina must be licensed, Review updated inspection reports, facility rating and penalties, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing. An official website of the State of North Carolina, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing, Mental Health, Development Disabilities and Substance Abuse Services, FY22_DMH Service Array with COVID-19 Services.xlsx. Transaction Control Number. 4 0 obj Listed below are the most common error codes not handled by Liberty Healthcare of NC. endobj Electronic Data Interchange refers to the electronc exchange of information between computer systems using a standard format. endstream Entity's National Provider Identifier (NPI). The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement. <>/Metadata 124 0 R/ViewerPreferences 125 0 R>> 2 0 obj endobj . endobj RFA&I:@aLzCOq'xO!b?'J(T+EF?o\J4%YvtO#i5OLv.JG &eRD&~KdS H"'xUU,x3K cC_f ILfB&=aOnnQo+H}h9736 G 7E&x}`)k\ v33M`zKR@;)~ft?N( rzXk'vHNK9:2A8faZ)zJ\2#4b9:_8]xE(c"8D `M NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). A lock icon or https:// means youve safely connected to the official website. Topics covered: pharmacy and durable medical equipment, behavioral health, transitions of care, specialized therapies, quality measures, network adequacy, provider directory, billing, incentive payments, clinical coverage policy updates, and more. Prior Approval (a.k.a. The Medicaid Contact Center isdedicated to assisting with inquiries regardingenrollment, claim status, recipient eligibility and other information neededbyprovidersto support their service toNCDHHS recipients. For billing information specific to a program or service, refer to theClinical Coverage Policies. <> Suspended (Prior Approval), Provider Policies, Manuals, and Guideline page, North Carolina Department of Health and Human Services. ORHCC is part of the N.C. Department of Health and Human Services supported by NCTracks. It is one of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. A. To Get A National Provider Identifier (NPI): Did you complete a service plan for the most current assessment for the beneficiary? Raleigh, NC 27699-2000. Department of Health and Human Services. Visit RelayNCfor information about TTY services. Welcome to NCTracks, the multi-payer Medicaid Management Information System for the N.C. Department of Health and Human Services (N.C. DHHS). However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. 9. It is the responsibility of the provider to clearly document that the beneficiary has met the clinical coverage criteria for the service, product or procedure. A lock icon or https:// means youve safely connected to the official website. Adjustments can be filed up to 18 months following the adjudication of the original claim. Once service records are updated, providers should receive payment at the previous level of service for the duration of the appeal process. The NC Medicaid Program requires provider claims payments to be by electronic funds transfer (EFT). A lock icon or https:// means youve safely connected to the official website. This status indicates your Prior Approval (PA) is still under review. State Government websites value user privacy. June 17, 2021 | Hot Topics with health plan Chief Medical Officers. For claims and recoupment please contact NC Tracks at 800-688-6696. NCTracks supports the following Divisons of the N.C. Department of Health and Human Services: Division of Health Benefits; Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; Division of Public Health; and Office of Rural Health. DHB includes Medicaid. Secure websites use HTTPS certificates. 5 0 obj Recipients must be eligible under one or more of the programs covered by the Divisions of the N.C. Department of Health and Human Services supported by NCTracks. FY22_DMH Service Array with COVID-19 Services.xlsx. Providers unable to find their practice associated with the correct health plans should reach out directly to the health plan to discuss contracting options. 2001 Mail Service Center NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. PROVIDERS - Click on the Providers tab above to enter the Provider Portal.RECIPIENTS - Click on the Recipients tab above to enter the Recipient Portal.STATE AND FISCAL AGENT STAFF - Click on the Operations tab above to enter the Operations Portal and ShareNET. A payment received from a Medicaid provider due to an erroneous payment. Exceptionsmay apply. If contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve. Calls are recorded to improve customer satisfaction.
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