Claim Submission FAQs

Effective with dates of service on and after 2/1/16, the below guidelines are to be followed, regardless of other insurance involvement:

• Institution based ambulance providers should file claims on an institutional claim form (UB04)

• Independent/private ambulance providers should file claims on a professional claim form (CMS 1500)  

Yes. NDCs should accompany vaccine claims.

No. Vaccines are not rebateable.

A new User Guide has been developed to assist with filing secondary claims to NCTracks. No paper submission is required - secondary claims can be billed electronically to NCTracks, either on the portal or as a batch electronic claims transaction. The User Guide "How do I Indicate Other Payer Details or an Override on a Claim in NCTracks and Batch Submissions", which is posted on the Provider User Guides and Training page of the Provider Portal, details step-by-step instructions for billing secondary claims to NCTracks.

A User Guide on How to View and Update Taxonomy is available on the Provider User Guides and Training page of the NCTracks Provider Portal. The guide provides step-by-step instructions for viewing and changing Taxonomy codes in your provider profile. Taxonomy codes remain the highest source of claim submission errors, so providers are encouraged to review their taxonomy codes on the portal and update them, if necessary.

A common error being found in claims keyed into the NCTracks Provider Portal involves the taxonomy code associated with the rendering provider. The group taxonomy code should not be used with the rendering provider. If it is, the claim will deny. Both the group and the rendering provider have their own taxonomy codes, which should be reflected on the claim.

The only exception to this is for Department of Mental Health (DMH) claims. DMH claims can have a group taxonomy code assigned to the rendering provider.

In order for a provider to receive eligibility information about a recipient, they must both be enrolled in the same benefit plan(s).  For example, if a provider renders services only for Medicaid, they would not be able to see a recipient's eligibility for Public Health services. 

When inquiring on recipient eligibility on the AVRS, the error message is "Provider number and recipient ID are not associated with the same benefit plan."  When inquiring on recipient eligibility on the provider portal, the error message is "Benefit plan information is not available because the recipient ID and provider number entered are not associated with the same benefit or health plan."

The implementation of NCTracks on July 1, 2013, included a requirement that a HCPCS code must be billed with all revenue codes on outpatient hospital claims. As noted in the January 22, 2014 provider portal announcement, that requirement has been changed. If the revenue code required a HCPCS code prior to July 1, then it will continue to do so. If the revenue code did not require a HCPCS code until after July 1, then it is no longer required, however, is encouraged to be billed on the claim when possible since DHB is capturing the data for future use. If a HCPCS code is submitted with a revenue code, it will need to be a current, valid HCPCS code on the date of service.

 

Outpatient claims billed with a revenue code but no procedure code will still report Edit 00435 (OUTPATIENT HOSPITAL CLAIM REQUIRE HCPCS CODE TO BE BILLED WITH REVENUE CODE) on the Remittance Advice (RA), but it will not cause the claim to deny. The EOB will be changed in the near future to remove the word “require”. Until then, the current EOB will be displayed and the line detail will be paid.

 

This change is effective based on date of processing, so claims previously denied for Edit 00435 can be resubmitted by the provider. For electronic claim submission, providers can submit a replacement claim to the previously denied claim and put the previous TCN as the replacement claim number, per the 837I billing guidelines.

The second most common error in billing is missing or invalid electronic funds transfer (EFT) information. Most paychecks and benefits are delivered straight to your checking account electronically, and NCTracks works the same way. Wrong or missing EFT does not affect the adjudication of claims, but it will prevent you from receiving payment. Use the Manage Change process in the Enrollment/Status and Management section of the secure Provider Portal to verify or update your EFT information. Any updates in EFT information will trigger a pre-note transaction with the bank to verify the information submitted. It can take up to six business days to complete the EFT pre-note process. Claims adjudicated for providers who do not have valid EFT information on file will suspend for 45 days awaiting an EFT update, after which they will deny.

For dates of service beginning November 1, 2016, the Carolina Access referral number (PCP NPI#) is no longer required to be submitted on the claim.

For dates of service beginning November 1, 2016, the Carolina Access referral number (PCP NPI#) is no longer required to be submitted on the claim.

A common billing error found in Institutional claims submitted through the NCTracks Provider Portal involves Admission Date and Admission Hour. Both Admission Date and Admission Hour are optional fields on the portal, but if you enter one of them, you have to enter both. Numerous occurrences have been found where providers billed Inpatient, Nursing Home, and Mental Health claims on the portal and entered only the Admission Date or the Admission Hour, but not both, which results in the denial of the claim.

For information regarding how to submit a claim, please attend one of the live provider informational sessions for assistance. Check the Provider User Guides and Training page for announcements on upcoming training or view a Computer Based Training course via SkillPort by clicking on the "Provider Training" button in the secure NCTracks Provider Portal. You may also request a provider onsite visit.

There could be several reasons, but NCTracks provides you with the status of your claims soon after you submit them, so it will tell you if a claim is denied and the reason for the denial. NCTracks will tell you the problem, and then you can resubmit with the correct information.

Your Remittance Advice (RA) will list all your claims submitted in a pay cycle and the status of each. For the denied claims, you can make corrections in time for the next payment cycle. Providers who need assistance in interpreting their RAs, which follow a different format than those in legacy systems, can find useful information in the NCTracks Remittance Advice Fact Sheet found here. A computer-based training course titled "How to Read Your Remittance Advice" is available 24/7 through SkillPort, the NCTracks Learning Management System, by clicking on the Provider Training button in the secure Provider Portal. (Access to the secure Provider Portal requires an NCID.) Providers are encouraged to spend some time analyzing the RA before turning to the Call Center for assistance.

If you depend on a trading partner or billing clearinghouse to submit claims and there was a problem with your claim submission, you may need to contact your trading partner to look into the difficulty. A listing of trading partners certified with NCTracks can be found here.

Finally, if your claims were approved and yet you don't get paid, check with the NCTracks Call Center at 1-800-688-6696.

 

Adjustments are processed within the checkwrite schedule

Per Clinical Coverage Policy No: 1A-22 - Prior approval is not required for Medicaid and NCHC recipients having circumcisions when medically necessary. Medical documentation supporting medical necessity can be uploaded as an attachment when submitting claims via the secure NCTracks Provider Portal.

No. Higher payment does not apply to services provided under another Medicaid benefit category such as clinic or Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). For more information, see the Medicaid Q&A here.

A list of modifiers can be found in the April Special Bulletin: Modifiers.
DHHS does make periodic updates, so look for special bulletins published on these changes. You may also refer to national CPT/HCPCS code books and clinical coverage policies.

Go to the NCTracks Provider Portal home page. On the left navigation bar, click Claims. On the sub menu choose Adjustment and Refunds. Open the PDF file “How to Submit Claim Adjustment and Time Limit and Medicare Overrides" and follow the steps. You will have to use a paper CMS 1500 claims form.

Request a site visit by a Provider Representative. On the bottom of any NCTracks web page there is a Contact link. Click that link, fill out the information on the form, and for the Subject choose “Request a Site Visit” from the drop-down menu. State the reason for your request and then click Send.

Claim attachments must include the Attachment Control Number (ACN) in order for the claim to process successfully. The ACN must be entered correctly on both the Claim and the Claim attachment cover sheet.

 

If the ACN on the claim attachment cover sheet is missing or does not match the ACN entered on the claim, then the claim attachments will not be accessible for the NCTracks claims team to review. The claim may deny if the attachments are necessary for processing.

Attach RA/EOB documents that show the claim has been submitted within the first 12 months and within the last 18 months. In most cases, it is the usually the same RA but could be multiple RAs/EOBs but the information submitted cannot have a time denial listed.

Only attach the relevant pages for the claim being submitted.

There is no plan to phase out the RA portion of the Time Limit Override Request at this time.