Claims Pended for Incorrect Location FAQs

This functionality was activated on May 25, 2014.  When a claim is received with an incorrect Billing, Rendering, or Attending Provider Location, the claim is pended in NCTracks. This occurs when the provider location submitted on the claim does not match the location(s) in the provider record.  Click on the link in the message and you will be taken to a screen where you can select the correct address from a drop down list. The claim will then be released into the system to continue processing. (You may receive more than one link per claim, if there is more than one address on the claim which is incorrect.)  For more information, see the User Guide "How to Update a Claim in the Pend Status resulting from an Incorrect Billing Location" on the Provider User Guide and Training page of the NCTracks Provider Portal.

The problem may be with the practice management software the provider is using. The provider may need to talk to the vendor for the practice management software.

You do not need to do anything about the pended claims, but you may need to make changes in your practice management software to ensure the correct location is used on future claims submitted to NCTracks.

The Office Administrator for the provider will need to submit a Manage Change Request to correct the location in NCTracks.

No.  If you change the location in your provider record in NCTracks, it will be used in processing future claims, but it does not resolve the claims already pended for incorrect location.  For information on how to resolve the claims already pended, see the User Guide "How to Update a Claim in the Pend Status resulting from an Incorrect Billing Location" on the Provider User Guide and Training page of the NCTracks Provider Portal.

If the Office Administrator (OA) for the Billing Provider is not the OA for the rendering (or attending) provider, they will need to contact the OA for the rendering (or attending) provider to get them to update the location information in NCTracks.

No.  If a claim pended for incorrect location is not corrected by the provider within 60 days, it will auto-deny. The provider will then need to resubmit the claim with the correct provider location. This will keep the claims from remaining pended indefinitely. The EOBs associated with the claims denied for incorrect location are:
4525 - Billing Locator Code Cannot Be Derived
4526 - Rendering Locator Code Cannot Be Derived
4527 - Attending Locator Code Cannot Be Derived
 

You may have had claims that were pended for incorrect location, which have now been denied.  An email with more information was sent to all affected providers on May 22.

No.

This step was taken for two reasons: 1) providers may have already resubmitted the claims with the correct location, and 2) providers who submitted claims through a clearinghouse or billing agent may not wish to correct them using the Provider Portal.

If you have not already refiled the claims with the correct location, you will need to do so. See the May 22 email sent to affected providers for instructions in consulting with your clearinghouse or trading partner to correct the location information and refile the claims.