Common Claims Error - Incorrect Billing Location

As of October 29, 2017, the N.C. Department of Health and Human Services (DHHS) validates through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider address, city, state, and zip code (first five digits) on all N.C. Medicaid and N.C. Health Choice claims must match exactly with the corresponding information on the provider record. (The match is not case sensitive.)

NCTracks uses the address submitted on the claim to match to a service location address on the provider’s record. The claim fields used for the match are:
• 837 D, P, and I – Loop 2010AA
• ADA Dental – Box 48
• CMS-1500 – Block 33
• UB04 – Form Locator 1

If NCTracks cannot match the billing provider's address to an active service location in the NCTracks provider's file, the provider will receive the informational EOB code 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE on the paper Remittance Advice (RA). This EOB indicates that the provider should add or correct the billing provider address on the provider’s record in NCTracks or correct the address submitted on the claim.

Note: The NCTracks team has noted a high occurrence of this edit posting to RAs. Providers should correct the billing provider address to prevent the error from reoccurring. The edit disposition of “pay and report” is temporary. (An announcement to providers will be made when the edit disposition will change to pend.) 

Provider records can be updated with a new billing provider address by submitting a Manage Change Request (MCR) in the secure NCTracks provider portal. Alternatively, providers can correct the billing provider’s address on the claim so it matches a service location on the billing provider’s record.

Note: MCRs may be subject to credentialing and verification. For guidance on submitting an MCR, refer to the User Guide, How to Change the Physical Address in NCTracks, in SkillPort.

Claims with dates of service prior to October 29, 2017, as well as all Pharmacy and crossover claims, are excluded from the edit. This edit does not apply to claims keyed directly into the secure NCTracks provider portal because the address must be correct before the claim can be submitted.