New Form for Provider Refund Requests

In an effort to provide consistency in provider refund requests, a new form has been developed and posted to the NCTracks website. Providers are encouraged to use this new form when submitting refunds to NCTracks.

Refunds may be due to NCTracks for a variety of reasons, including billing errors, overpayments, and claims reprocessing resulting in an accounts receivable, among others. In some cases, providers may need to submit a claim adjustment to enable the claim information in the system to be updated accurately.

When a claim adjustment is submitted to NCTracks, the system will recoup the funds as needed. However, if the provider's paid claims in that checkwrite cycle are not sufficient to cover the recoupment, an accounts receivable will be created. Rather than waiting on an automated recoupment of the accounts receivable, which will not begin for 30 days, providers may choose to submit a refund check to NCTracks.

When submitting a refund, there are several key considerations to keep in mind:

1. Refunds are specific to a payer. Payers supported by NCTracks include Medicaid, Health Choice (NCHC), DMH, and DPH. If you have refunds for multiple payers, please submit separate forms and separate checks for each payer. If a single check is received for multiple payers, it will be returned to the provider. It is also important that the form and check be mailed to the correct address. Note the address for each Payer listed on the Provider Refund Form.

2. Refunds are specific to an NPI. If you have refunds for multiple NPIs, please submit separate forms and separate checks for each NPI. If a single check is received for multiple NPIs, it will be returned to the provider.

3. Please complete all fields on the form, according to the instructions. Incomplete forms will delay processing.

4. If the refund is claim(s) specific, for Medicaid and NCHC services, the provider is to adjust the claim(s) and submit the adjustment(s) to NCTracks following the billing guidelines for adjustment claims.

The new NCTracks Provider Refund Form, along with Instructions for completing the form, can be found in the Provider Forms section of the Provider Policies, Manuals, and Guidelines page of the NCTracks Provider Portal. (See link below)

If you have any questions about the provider refund request process, please contact the NCTracks Call Center at 1-800-688-6696.