Incorrect Recoupment Following Retroactive MCO Enrollment

As previously announced, beginning May 1, 2016, NCTracks began a new process of handling retroactive enrollment in a Managed Care Organization (MCO.) When new or updated eligibility and enrollment records are received from NC FAST, NCTracks creates new capitation claims or voids and recoups previously paid capitation claims, based on the retroactive change in MCO enrollment. In addition, fee for service claims for behavioral health services that are covered by the MCO, which paid during the time the recipient was retroactively enrolled in the MCO, are systematically voided and the payment recouped.

However, it was recently learned that some pediatric fee for service claims for services not covered by the MCO were incorrectly voided and recouped following retroactive MCO enrollment. This issue is being corrected in NCTracks and the claims that were incorrectly voided and recouped will be systematically reprocessed. When the reprocessing is scheduled, a separate communication will be sent to affected providers. No action is required.