Automation of Prior Approval Update with Change of Ownership

When a Change of Ownership (CHOW) occurs and the purchasing provider plans to continue rendering services for which the seller has already received prior approval (PA), additional steps are required. Because the purchasing provider’s number is not on the seller’s PA, the seller’s PA must be end-dated and a new PA record must be created under the purchasing provider’s number.

Historically, the PA update process required by a CHOW was handled as a manual process. On October 29, 2017, NCTracks will automate the end-dating of existing seller PA records and systematically create new PA records under the purchasing provider. Automation will simplify and expedite the process, allowing the purchasing provider to render services that require PA and receive payment in a more efficient manner.

Note: None of the actions defined for the PA CHOW functionality can occur until the purchasing provider is enrolled in NCTracks. When the purchasing provider is enrolled in NCTracks, Division of Medical Assistance (DMA) Clinical Policy (919-855-4260) should be notified about the CHOW. DMA will provide an official memo to NCTracks with documentation regarding the purchasing provider and the seller to provide direction to NCTracks to complete an automated CHOW transaction.

Some PA records require special handling under the automated CHOW process:

• Automated CHOW exceptions. There are some exceptions to the automated CHOW process. This new feature only applies to PA requests submitted to and approved by NCTracks. For PA records submitted to NCTracks through a State vendor, such as eviCore for radiology, the billing or rendering provider is responsible for working with the vendor to upload a new and correct PA record to NCTracks.
• When new PA requests are required. Some services will require the purchasing provider to submit a new PA request; for example, services requiring the purchasing provider to prepare an updated plan of care. The purchasing provider should indicate in the new PA request that the request is being submitted because of a CHOW.
• Hospice existing and overlapping PA records. Hospice PA records are auto-approved or denied based on auto-decision rules. For Hospice PAs, any existing and overlapping PA records under the seller would first need to be end-dated before the purchasing provider submits a new PA request.
• PA requests not affected by CHOW. Some types of PA requests are not impacted by a CHOW, including Long Term Care, Refraction Confirmation, and Pharmacy.

For more information on the CHOW process in NCTracks, refer to the July 7, 2015, announcement on the provider portal. Existing NCTracks provider training materials in SkillPort are being updated to reflect the new automated CHOW process.