Updates from the NCMGMA Medicaid Committee

  • The ICD-10 transition was for the most part a smooth switch. Successful claims adjudication rate for ICD-10 claims is the same or higher than ICD-9 claims across all programs. The most common reasons for ICD-10 claim rejections at this point are incorrect code set qualifier and/or lack of valid ICD-10 diagnosis on the claim. See the NCTracks ICD-10 help pages for further details if you are experiencing claim rejections.
  • Credentialing:
    • Re-credentialing: Providers are required to re-credential with Medicaid every five years in order to continue program participation. The re-credentialing process, which was put on hold soon after NCTracks implementation, is starting back up in November. The first set of re-credentialing invitations will be sent out through the NCTracks portal on November 15th. NCTracks has estimated that around ten thousand North Carolina providers will receive an invitation in the first round. Invitations will appear as messages in the NCTracks message inboxes for each affected providers’ OA. The will also be an option to re-verify at the bottom of the Status & Management page. Providers will have 45 days to respond. If NCTracks does not receive a re-credentialing response by January 1st, 2016, payments for the NPI that failed to re-credential will be suspended. Failure to respond by January 31st, 2016 will lead to termination of the provider’s enrollment record and providers will be required to re-apply. Look for more information to be published on DMA’s provider website soon. Make sure to check your NCTracks inbox the week of November 15th and take action if a re-credentialing notice is received!
    • Other enrollment news:
      • Users who experience problems with applications or manage change requests, particularly any error messages that prevent submission, should contact NCTracksprovider@nctracks.com.
      • DMA and CSC continue to work with the NC Medical Board on implementation of an automated process for import and update of medical license numbers/effective dates. It is anticipated the system interface will be implemented in May 2016.
  • Eligibility: CCNC program: Carolina Access PCP auto-assignment began in September and is still ongoing; patients who were not previously assigned to a specific PCP have had a PCP auto-assigned, and some patients that were assigned in the past have had PCP changed . Providers are encouraged to check eligibility and verify each patient’s assigned PCP with every visit. If providers are unable to obtain a CCNC/CA Referral Authorization from the assigned PCP of record prior to rendering treatment, an override may be requested. See further details in the September special bulletin. Recipients may call the DMA call center at 1-888-245-0179 to change their assigned Carolina Access PCP.
  • MedSolutions: NCTracks and MedSolutions have formed a small task force which continues to meet to address issues whereby authorizations and other relevant information are not communicated between the two systems in a timely and consistent manner and work towards resolution.
  • Specialty specific issues:
    • Anesthesia services:
      • $3 copays continue to be applied to anesthesia claims even though benefits verifications in NCTracks assign a $0 copay to anesthesia. DMA clinical policy team and finance team members are researching this data mismatch to determine whether copay should be applied.
      • Same day anesthesia
    • Sterilization consent forms:
      • Medicaid is looking into the possibility of updating denial message on claims submitted for patients with missing or invalid consent forms in order to further differentiate whether the form is actually not on file or whether form is on file but incomplete or invalid in an attempt to help providers troubleshoot claims denials more effectively.
      • NCMGMA continues to advocate for accessibility of consent forms for all providers involved in a patient’s care, including blind providers
      • NCMGMA continues to advocate for the ability to upload consent forms electronically within NCTracks
    • Physician Drug Program: DMA is aware that some vaccines and other injectable drugs are being reimbursed under cost due to the Drug Program rate freeze. Efforts are underway to try to lift the rate freeze. Affected providers may attempt to appeal reimbursement rates by submitting a written reconsideration request to the DMA Budget Office, 2501 Mail Service Center, Raleigh, North Carolina 27699-2501. Requests must be signed by the provider and must include the provider’s name, address, telephone number and the specific reason(s) for the appeal request.
  • Annual Visit limit reductions: the proposed reduction in the number of covered visits per year is still under review by CMS. If approved, the soonest that the reduction could be implemented in NCTracks would be late spring 2016. More information on any changes will be shared as soon as it becomes available.

The Medicaid Committee continues to advocate on behalf of the provider community for program and policy changes that will reduce operational inefficiencies and provide further transparency in clinical and financial policies. Please contact Leah Paraschiv, Medicaid Committee Chair, at L.Paraschiv@msochealth.com if you are interested in joining the committee or to discuss any concerns with North Carolina Medicaid.

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