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 payment received from a Medicaid provider due to an erroneous payment. Claim Adjustment Reason Codes | X12 For claims and recoupment please contact NC Tracks at 800-688-6696. Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. However, providers can also submit paper forms via mail or fax. Usage: This code requires use of an Entity Code. These denials are then re-adjudicated by Vaya without action required from the provider. A provider must have thenine-digit ABA routing number for their bank and their checking account number to sign up for electronic funds transfer (EFT) of payments from NCTracks. Ensure beneficiary eligibility on the date of service, Guarantee that a post-payment review that verifies a service medically necessary will not be conducted. May be done automatically as part of claims reprocessing. 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. 2 0 obj Just getting started with NCTracks? When a change in authorized service level goes into effect, the old authorization will end and the new authorization will begin. For billing information specific to a program or service, refer to theClinical Coverage Policies. Healthy Opportunities Screening, Assessment and Referrals Claims Issue 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). For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page. NCTracks - FY 2022 Documents | NCDHHS Calls are recorded to improve customer satisfaction. However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. The Remittance Advice is an explanation to providers regarding paid, pending, and denied claims. 6pRBu5U/rtCk$]TNBrFhL\ssmUFMWAtp $#b;;`3.b(fi^z:h;/\QOS\f3:L NZN%[HEqYFKD e{k1Sq!uH.v;4fM 8D ` x?/ 2001 Mail Service Center NC DHHS: Providers <>/Metadata 124 0 R/ViewerPreferences 125 0 R>> Usage: This code requires use of an Entity Code. Customer Service Agents are available to answer questions at this toll-free number:Phone: 800-688-6696. ORHCC is part of the N.C. Department of Health and Human Services supported by NCTracks. Documents. JFIF ` ` C Theprovider who referred the patient for the service specified on the submitted claim. Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity. NCTracks is updating the claims processing system as inappropriately denied codes are received. 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 contracting with health plans through a Clinically Integrated Network (CIN), providers should reach out to their CIN to resolve. The person receiving services from a provider. stream Claims specialists may contact providers to alert them of any other denials the provider needs to correct and resubmit. FY22 DMH BP Hierarchy. endstream Reversal of a paid claim, either at the provider's request or as part of an automated recoupment. The ordering provider is responsible for obtaining PA; however, any provider . A. Inquiries may be submitted to Medicaid.ProviderOmbudsman@dhhs.nc.gov or the Medicaid Managed Care Provider Ombudsman at 866-304-7062 (NEW NUMBER). Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks. 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. For questions related to your NCTracks provider information, please contact the NCTracks Call Center at 800-688-6696. They include the Social Security Number (SSN) and Employee Identification Number (EIN). The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement. 8 0 obj Claims Denied - Taxonomy Codes Missing, Incorrect, or Inactive Other insurance companies responsible for medical coverage; their claims must process and pay or deny before State processing. Raleigh, NC 27699-2000. NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). Office of Rural Health and Community Care. endobj 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. Medicaid is the payer of last resort. A lock icon or https:// means youve safely connected to the official website. <> FY22_DMH Budget Criteria.xlsx. Previously referred to as the Medicaid ID. ",#(7),01444'9=82. 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. NCTracks staff from provider enrollment, provider relations, claims, and prior approval will be available to assist NC providers with questions or concerns regarding NCTracks.