NCTracks Glossary of Terms

American Bankers Association. A provider must have the nine-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 Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. 

American Dental Association.  The professional association of dentists committed to the public's oral health, ethics, science, and professional advancement.  NCTracks uses the ADA Form for dental prior approval and claim submission.

A submitted claim that has either been paid or denied by the NCTracks system.

A claim transaction that changes the payment amount and/or units of service of a previously paid claim.

The amount of the claim charge that Medicaid will pay for a particular service; the allowed amount is usually the lesser of the charged amount or a maximum allowed associated with the service.

The American National Standards Institute reviews, evaluates, and make recommendations relating to electronic transactions for certain industries, including health insurance, and the format of those data submissions.

Automated Voice Response System.  The NCTracks AVRS provides information on recipient eligibility, claim status inquiry, checkwrite amount, and prior approval for the Division of Public Health.  Providers can access the AVRS by dialing 1-800-723-4337.  For an explanation of the prompts, see the AVRS Features Job Aid under Quick Links on the NCTracks Provider Portal home page.

Primary care case management program through the networks of Community Care of North Carolina.  For more information about Carolina ACCESS (CCNC/CA), see the related DHB webpage at https://medicaid.ncdhhs.gov/providers/programs-and-services/community-care-north-carolinacarolina-access-ccncca.

Claim Adjustment Segment

Division of Health Benefits (new name for the Division of Medical Assistance or DMA). It is one of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. DHB includes Medicaid and Health Choice. For more information, see the NC DHB website.

Department of Health and Human Services.  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.  For more information, see the NC DHHS website.

Division of Medical Assistance (DMA) was the previous name of the Division of Health Benefits (DHB). It is one of the Divisions of the N.C. Department of Health and Human Services served by NCTracks. DHB includes Medicaid and Health Choice. For more information, see the NC DHB website.

Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.  One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks.  For more information, see the NC DMH/DD/SAS website.

Division of Public Health.  One of the Divisions of the N.C. Department of Health and Human Services served by NCTracks.  For more information, see the NC DPH website.

Electronic Data Interchange refers to the electronc exchange of information between computer systems using a standard format. NCTracks uses the ANSI ASC X12 standards, which includes transations for claim submission, eligibility verification, and remittance advice, among others. For more information, see the Trading Partner Information webpage on the Provider Portal.

Electronic Funds Transfer.  EFT is the electronic exchange of money from one financial institution account to another through computer-based systems.  Payment from NCTracks to providers is made through EFT.

Explanation of Benefits

Infant-Toddler Program of the NC Division of Public Health

Local Management Entity responsible for behavioral health providers. For more information, see the website for the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS)

Medicaid Management Information System - the mechanized claims processing and information retrieval system which states are required to have for the Medicaid program

Month-to-Date

NCTracks is a multi-payer system that consolidated several claims processing platforms into a single solution for multiple NC DHHS divisions

National Drug Code

The National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).  Providers who use NCTracks are required to have an NPI.

Office Administrator - The owner or managing employee of a provider organization responsible for maintaining the provider record.  Every NPI must have an OA, but a single OA may be responsible for multiple NPIs.

Office of Rural Health and Community Care.  ORHCC is part of the N.C. Department of Health and Human Services supported by NCTracks.  For more information, see the ORHCC website.

See "Suspend (Claims)"

This status indicates your Prior Approval (PA) is still under review.  For more information on PA status codes, see the Prior Approval FAQs.

Prior Approval (a.k.a. Prior Authorization) - For more information regarding Prior Approval and NCTracks, see the Prior Approval webpage on the Provider Portal.

A Primary Care Physician (or Primary Care Provider) is a provider who has responsibility for oversight of the medical care of a recipient.  For more information, see CCNC/CA

Protected Health Information - information about health status, provision of health care, or payment for health care that can be linked to a specific individual

Remittance Advice.  The Remittance Advice is an explanation to providers regarding paid, pending, and denied claims.  A Remittance Advice is generated during each checkwrite cycle for every NPI.  A link to the Remittance Advice is posted to the Message Center Inbox in the secure NCTracks Provider Portal.

The person receiving services from a provider.  Recipients must be eligible under one or more of the programs covered by the Divisions of the N.C. Department of Health and Human Services supported by NCTracks.  (Also known as Beneficiary.)

The identification number assigned to a recipient of services from one or more Divisions of the N.C. Department of Health and Human Services (NC DHHS).  Previously referred to as the Medicaid ID.

A payment received from a Medicaid provider due to an erroneous payment.  May be done automatically as part of claims reprocessing.

The provider who referred the patient for the service specified on the submitted claim.

In North Carolina, the State Fiscal Year is from July 1 to June 30.

Holding of a claim for another checkwrite cycle so that eligibility, budget, or other issues can be corrected. This allows a claim to be corrected and processed without being resubmitted. A claim in this state is said to be "pended."

This status indicates that your Prior Approval (PA) is new and being reviewed by a clinical specialist for a decision.  This is the typical initial state of a PA request that has been submitted to NCTracks.  For more information on PA status codes, see the Prior Approval FAQs.

Transaction Control Number.  The system-assigned number used to track a claim throughout the processing steps in NCTracks.  (Similar to an ICN in the legacy system.)

The standard for initial filing of claims is up to 12 months from the date of service. Adjustments can be filed up to 18 months following the adjudication of the original claim. 

Overrides may be granted and can be requested using the Medicaid Inquiry Resolution Form under the Provider Forms section of the Provider Policies, Manuals, and Guideline page of the NCTracks Provider Portal.

A Taxpayer Identification Number (TIN) is a number used by the Internal Revenue Service (IRS) to record and track tax payments. There are several types of TINs that vary according to taxpayer category. They include the Social Security Number (SSN) and Employee Identification Number (EIN).

Federal regulations that govern the Medicare program under Title XVIII (18) of the Social Security Act.

Federal regulations that govern the Medicaid program under Title XIX (19) of the Social Security Act.

Federal regulations that govern the State Children's Health Insurance Program under Title XXI (21) of the Social Security Act, also known as North Carolina Health Choice (NCHC)

Third Party Liability.  Other insurance companies responsible for medical coverage; their claims must process and pay or deny before State processing. Medicaid is the payer of last resort.

A Trading Partner Agreement (TPA), defined in 45 CFR 160.163 of the transaction and code set rule, is a contract between parties who have chosen to exchange information electronically. A TPA is required to submit electronic ASC X12 transactions to NCTracks.  For more information about TPAs, see the Trading Partner Information page of the NCTracks Provider Portal.

Reversal of a paid claim, either at the provider's request or as part of an automated recoupment. There are some critical errors, such as wrong NPI or recipient ID that cannot be corrected by an adjustment, in which case the provider would void the original claim and may submit a replacement claim.

Year-to-Date.  May refer to Fiscal Year-to-Date (FYTD) or Calendar Year-to-Date (CYTD)