Additions/Enhancements to Recipient Eligibility Inquiry/Response

On February 1, 2016, a number of additions and enhancements are being made to the NCTracks Recipient Eligibility Inquiry/Response in addition to the expanded time frame noted in the January 20 announcement. (See link below.) These changes affect the Automated Voice Response System (AVRS), provider portal, and the X12 270/271 transaction.

Providers who use the secure NCTracks portal to verify eligibility will notice some changes in the layout of the web pages. Several fields have been moved to improve the ease of use of the screens and narratives have been added or modified to enhance the clarity of the information being requested and displayed. Modifications to the narrative have also been made to the AVRS response.

Messages were added to identify beneficiaries with limited or restricted benefits due to their eligibility coverage. Examples of the new responses include:

RESTRICTIVE COVERAGE, INPATIENT SERVICES AT A HOSPITAL ONLY
RESTRICTIVE COVERAGE, EMERGENCY HEMODIALYSIS SERVICES ONLY
PRESUMPTIVE COVERAGE, AMBULATORY PREGNANCY-RELATED SVCS ONLY

January 20 announcement

The Health Care Eligibility Benefit Inquiry and Response (270/271) Companion Guide has been updated to reflect these enhancements and posted on the Trading Partner Information page of the NCTracks Provider Portal. The AVRS Features Job Aid under Quick Links on the Provider Portal Home Page has also been updated.

Computer Based Training (CBT) course RCP131 Recipient Eligibility Verification has been updated in SkillPort, the NCTracks Learning Management System, as has the Participant User Guide associated with the Instructor Led Training course RCP181 Recipient Eligibility Verification. To access these courses, logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled Provider Computer-Based Training (CBT) and Instructor Led Training (ILT). The courses can be found in the sub-folders labeled CBTs and PUGs, depending on the format of the course.  Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort. The Provider Training page also includes a quick reference regarding Java, which is required for the use of SkillPort.