DHHS currently has eight LME-MCOs operating under the 1915 b/c Waiver. Notes: Use code 16 with appropriate claim payment remark code. A Primary Care Physician (or Primary Care Provider) is a provider who has responsibility for oversight of the medical care of a recipient. 91 Entity not eligible/not approved for dates of service. The Medicaid Contact Center isdedicated to assisting with inquiries regardingenrollment, claim status, recipient eligibility and other information neededbyprovidersto support their service toNCDHHS recipients. read on Getting Started With NCTracks, This section includes User Guides and Fact Sheets designed to help N.C. DHHS providers understand how to use NCTracks, as well as information about Provider Training. 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[~\ Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. However, there may be a delay in making a decision if Medicaid needs to obtain additional information about the request. 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. Prior Authorization)- For more information regarding Prior Approval and NCTracks, see the Prior Approval webpage on the Provider Portal. Interim reports are temporarily available on the Managed Care Provider PlaybookTrending Topicspage to assist providers in verifying their records. AmeriHealth Caritas: 888-738-0004 Carolina Complete: 833-522-3876 Healthy Blue: 844-594-5072 United Healthcare: 800-638-3302 hb```f``Z {AX,X9pHQuu4~hLGGPd`1@,65A9I:Ac+XDk\X"E]Q|S0`refb`w0)[( , <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 10 0 obj 8 0 obj 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. There are some critical errors, such as wrongNPI or recipientID that cannot be corrected by an adjustment, in which case the provider would void the original claim and may submit a replacement claim. <> Follow these easy steps to begin using the new system. The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. A. The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. % 282N00000X and 3112A0620X). Are you billing within the approved effective dates. Retroactive prior approval is considered when a beneficiary, who does not have Medicaid coverage at the time of the procedure, is later approved for Medicaid with a retroactive eligibility date. Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal. endobj For all other types of PA requests, Medicaid will make every effort possible to make a decision within 15 business days of receipt of the request unless there is a more stringent requirement. 2455. 2001 Mail Service Center This guide will assist providers with direction on how to enter primary payer information such as CARCs, CAGCs and the adjustment amount. A lock icon or https:// means youve safely connected to the official website. 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).
