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Side Nav. A TPA is required to submit electronic ASC X12 transactionsto NCTracks. However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. <> 2 0 obj The Delay Reason Codes currently accepted in NCTracks are third-party processing delay (#7) and the original claim was rejected or denied due to a reason unrelated to the billing limitation rules (#9). 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. 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. endobj The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement. <> The standard for initial filing of claims is up to 12 months from thedate of service. endobj A lock icon or https:// means youve safely connected to the official website. 11 0 obj <> 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. 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). This status indicates that your Prior Approval (PA) is new and being reviewed by a clinical specialist for a decision. Claims are processed in real time. 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. NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). Updated Guidance for New Denial Code- Taxonomy Invalid for Claim Form 10 0 obj endobj 282N00000X and 3112A0620X). A claim in this state is said to be "pended.". Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal. One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. endobj EFT is the electronic exchange of money from one financial institutionaccount to another through computer-based systems. The NCTracks team is offering another in-person Provider Help Center on March 7 in Raleigh. Below are some of the sessions most helpful for Managed Care launch. NCTracks uses the ANSIASC X12 standards, which includes transations for claim submission, eligibility verification, and remittance advice, among others. State Government websites value user privacy. The system-assigned number used to track a claim throughout the processing steps in NCTracks. 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). This status indicates your Prior Approval (PA) is still under review. For more information, see the NC DMH/DD/SAS website. The ordering provider is responsible for obtaining PA; however, any provider . NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). In North Carolina, the State Fiscal Year is from July 1 to June 30. 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. hbbd```b``3@$Sd9 "`m One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. For prescription drugs requiring PA, a decision will be made within 24 hours of receipt of the request. Visit RelayNCfor information about TTY services. Medicaid researches requests to determine the effectiveness of the requested service, procedure or product to determine if the requested service is safe, generally recognized as an accepted method of medical practice or treatment, or experimental/investigational. A submitted claim that has either been paid or denied by the NCTrackssystem. d4-L+_ocHkI.J`zF8;|[&^#)(Wq'ld\Ks0UM[o/6r1-=$_7Ig05J_ P5-I1(1TsAs4xZjez(OB)Z.VpE!.faM}Mqy W2i)U7xo)> R=q[ An official website of the State of North Carolina, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). Interim reports are temporarily available on the Managed Care Provider PlaybookTrending Topicspage to assist providers in verifying their records. The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. stream &Vy,2*@q?r 6y@$Y 9 $309}0 b Just getting started with NCTracks? 1 0 obj read on Provider Re-credentialing/Re-verification, Provider Re-credentialing/Re-verification, North Carolina Department of Health and Human Services. PROVIDERS - Click on the Providers tab above to enter the Provider Portal. The Medicaid Contact Center isdedicated to assisting with inquiries regardingenrollment, claim status, recipient eligibility and other information neededbyprovidersto support their service toNCDHHS recipients. FY22_DMH BP Concurrency Table.xlsx. NCTracks Contact Center Customer Service Center:1-800-662-7030 8 0 obj As NC Medicaid moves forward with the implementation of NC Medicaid Managed Care, it is important enrolled providers use these resources to thoroughly review their individual and organization provider enrollment information and submit changes as needed using the Manage Change Request process. 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.