Claims Pended for Incorrect Billing Location

Effective October 29, 2017, the NC Department of Health and Human Services (DHHS) will implement in NCTracks the validation of the billing provider address submitted on the claim to the location listed on the provider record for the date(s) of service submitted. The billing provider address, city, state, and zip code (first 5 digits) on all Medicaid and North Carolina Health Choice claims must match exactly with the corresponding information on the provider record. (The match is not case sensitive.)

If NCTracks cannot match the billing provider's address to an active service location in the NCTracks provider's file, the claim will be pended for 60 days to give the billing provider time to add the address. The pended claim will be displayed on the paper Remittance Advice (RA) with Explanation of Benefits (EOB) code 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE. Providers should verify the address submitted on the claim is a valid and active address on the provider’s record.  Double check for spelling errors on the claim and/or NCTracks. This EOB indicates that the provider should add or correct the billing provider address in NCTracks or correct the address submitted on the claim.

Claims pended with EOB 04529 will automatically recycle daily, so if the provider adds the correct address to the provider record, the claim will resume processing. If the provider does not add the correct address to the provider record within 60 days, the system will deny the claim.

The provider record can be updated with a new billing provider address by submitting a Manage Change Request (MCR) in the secure NCTracks provider portal or correcting the billing provider’s address on the claim to a service location on the billing provider’s record. Note that the MCR may be subject to credentialing and verification. For guidance on submitting the 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, will not be subjected to the new business rules. Pharmacy and crossover claims will be excluded from the new business rules.