Reprocessing of claims for ACA payment - Correction

The Affordable Care Act (ACA) requires that the Medicaid program pay at the Medicare rate for certain primary care services and to reimburse 100% Medicare Cost Share for services paid in calendar years 2013 and 2014 to attested providers. In September 2013, NCTracks began making the ACA enhanced rate payments to providers who attested and were verified by the state for qualified services billed from that point forward. In September 2014, the Centers for Medicare and Medicaid Services (CMS) approved a North Carolina State Plan Amendment which changed the allowable attestation date from June 30, 2013, to June 30, 2014, for retroactive ACA payment eligibility back to January 1, 2013. (Providers who attested after June 30, 2014, are eligible for enhanced ACA payment for services rendered after their attestation date.)

NCTracks has since been updated to include information regarding providers who attested at a later date, as well as changes in rates effective January 1, 2014. (ACA eligible claims with a date of service on or after January 1, 2014, that adjudicated on or before March 7, 2014 at 10:00 a.m. paid with the old rates.) Now that these changes are complete, retroactive reimbursement is starting. No action is required on the part of attested providers to receive retroactive reimbursement.

Beginning on January 17, 2015, NCTracks will start the reprocessing of paid physician claims for enhanced ACA payments of eligible services. The reprocessing will include physician claims processed and paid with dates of service from January 1, 2013, through December 31, 2014, that did not already receive enhanced ACA payment.

The claim reprocessing will likely take several checkwrites, and should be completed by mid-February. The claims will be reprocessed as Adjustments and will be reported on the providers Remittance Advice (RA). On the paper RAs only, the reprocessed claims will be listed in a separate section of the RA and the claims will be reported with an EOB code of 06040 - "CLAIM REPROCESSED FOR ACA ADJUSTED PAYMENT."

The 835 transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)

This is the second reprocessing effort and we do not anticipate additional reprocessing of previously paid claims for enhanced ACA payments. Individual reprocessing, if needed, will be addressed on a case by case basis. New claims for eligible services from 2014 rendered by attested providers will be reimbursed appropriately.