4 0 obj Prior approval is issued to the ordering and the rendering providers. June 17, 2021 | Hot Topics with health plan Chief Medical Officers. Federal regulations that govern theState Children's Health Insurance Program under Title XXI (21)of the Social Security Act, also known as North Carolina Health Choice (NCHC). 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. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone.Phone: 800-723-4337, This page was last modified on 01/25/2023, An official website of the State of North Carolina, Rules and exceptions for providers billing beneficiaries, NCTracks claims processing and provider enrollment system. A submitted claim that has either been paid or denied by the NCTrackssystem. This status indicates your Prior Approval (PA) is still under review. Key milestone dates, where to turn for help, Provider Playbook, PHP quick reference guides, webinars, Provider Directory, Help Center and Provider Ombudsman. To learn more, view our full privacy policy. The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are required to use ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2015. The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: *PHP may be updating their denial/rejection code description. These denials are then re-adjudicated by Vaya without action required from the provider. CMS Guidance: Reporting Denied Claims and Encounter Records - Medicaid Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. This allows a claim to be corrected and processed without being resubmitted. 9 0 obj 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. Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal. endstream 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. For more information, see the NC DMH/DD/SAS website. However, providers can also submit paper forms via mail or fax.
