NCTracks Coming Attractions - Changes Arriving October 28, 2018

Several changes are coming to the NCTracks system this October. Get the run down of each one below:

Tax-Related Updates to NCTracks

The Internal Revenue Service limits acceptable taxpayer names to the following characters: Alpha (A-Z), Numeric (0-9), Hyphen (-), and Ampersand (&). Names also may not contain more than two spaces in a row. To ensure clean reporting of Organization and Doing Business As (DBA) names to the IRS, three NCTracks changes are being implemented on October 28, 2018:

• A one-time system edit and update will be processed to remove any non-allowable characters or extra spaces that currently exist in Organization and DBA taxpayer names.  All provider organizations sharing the same Taxpayer Identification Number (TIN) will be updated automatically to report the same taxpayer name.
• When completing an enrollment application, a validation edit will display errors if non-allowable characters are entered in taxpayer names.
• Individual providers who choose to report their income using an Employer Identification Number (EIN) will now be required to enter a DBA name for that employer.

The Fiscal Agent periodically performs a TIN Match function with the IRS. This function identifies any providers whose NCTracks’ tax name and/or TIN are not in agreement with official IRS records. Any providers with TIN Matching errors will be contacted by the Fiscal Agent for corrective actions. When providing enrollment information, please be sure to use the taxpayer name and TIN provided by the IRS.

 

Service Limit Updates for CAP/CH, CAP/DA, and CAP/CO Procedure Codes

As of October 29, 2018, new service limits and audits have been created for CAP/DISABLED ADULTS (CAPDA), CAP/CHILDREN (CAPCH), and CAP/Choice (CAPCO) for procedure codes T1016, T2029, T2039, T2041 and S5165.

The following changes will apply:

• Medicaid will limit reimbursement for CAPDA services billed with procedure code T1016 to 320 units per recipient per calendar year effective January 1, 2017.
• Medicaid will limit reimbursement for CAPCH services billed with procedure code T1016 to 320 units per recipient per calendar year effective March 1, 2017.
• Medicaid will limit reimbursement for CAPCO services billed with procedure code T2041 to 320 units per recipient per calendar year effective January 1, 2017.
• Medicaid will limit reimbursement for CAPCH services billed with procedure code T2041 to 320 units per recipient per calendar year effective March 1, 2017.
• Medicaid will limit reimbursement for the CAPCH to a $31,000 maximum for procedure codes T2029 based on the accumulation of payments for the combination of T2029, T2039, and S5165 claims over the waiver lifetime for CAPCH. Paid claims details for procedure codes T2029, T2039, and S5165 within the current waiver lifetime cycle will be identified and claims for T2029 will be denied if the claim would cause the limit to exceed $31,000, effective of March 1, 2017 ending February 28, 2023.
• Medicaid will limit reimbursement for the CAPCH to a $28,000 maximum for procedure codes T2039 and S5165 based on the accumulation of payments for the combination of T2029, T2039 and S5165 claims over the waiver lifetime. Paid claims details for procedure codes T2029, T2039 and S5165 within the current waiver lifetime cycle will be identified and claims for T2039 or S5165 will be denied if the claim would cause the limit to exceed $28,000, effective March 1, 2017 through February 28, 2023.

The following table identifies the procedure codes that require new service audits to expand utilization limits:

Edit ID	Procedure Code	Effective Dates	Limits	CAP CH	CAP CO	CAP DA
A- 59300	T2041	1/1/2017 – Ongoing	320 units annual calendar year		X
B-59310	T2041	3/1/2017 – Ongoing	320 units annual calendar year	X
C-59320	T1016	1/1/2017 – Ongoing	320 units annual calendar year			X
D-59330	T1016	3/1/2017 – Ongoing	320 units annual calendar year	X
E-59340	T2029	3/1/2017 – 2/28/23	$31,000 per a waiver lifetime cycle in combination with T2029, T2039 and S5165	X
F-59350	T2039 and S5165	3/1/2017 – 2/28/23	$28,000 per a waiver lifetime cycle in combination with T2029, T2039 and S5165	X

 

DMEPOS Adult PAs for Non-covered, Unlisted or Restricted Items to be Adjudicated by GDIT Starting October 28

Historically, prior approval (PA) requests for Durable Medical Equipment, Orthotics, Prosthetics, and Supplies (DMEPOS) not covered for recipients aged 21 and over, unlisted or otherwise restricted in NC Medicaid policy were submitted directly to NC Medicaid for medical necessity review and claims adjudication. More recently these PA requests and claims could be submitted through NCTracks, but were still reviewed by NC Medicaid clinical policy staff.

Beginning October 28, 2018, GDIT will assume responsibility for this medical necessity review and claims adjudication function. Providers should continue to submit all PA requests for adult non-covered, unlisted or restricted DMEPOS items and subsequent professional claims through NCTracks. Providers are not required to alert GDIT to the presence of a non-covered, unlisted or restricted item in a DMEPOS PA request as a precondition for review. All items requested in DMEPOS PA requests will be reviewed for medical necessity whether listed in policy or not and whether restricted in policy or not.

Providers may continue to request non-covered, unlisted or restricted items using their identifiable HCPCS code (e.g.: E1012). If no HCPCS code exists, providers may use the miscellaneous combination K0108/W4005 for wheelchair accessories only, and for non-wheelchair items, the miscellaneous combination E1399/W4047.

GDIT will use existing policy as well as medical necessity review guidelines provided by NC Medicaid in the review and disposition of adult non-covered, unlisted or restricted DMEPOS PA requests.

PAs previously approved by NC Medicaid already exist in NCTracks and should not be resubmitted. Unpaid claims for these existing PAs should also be submitted through NCTracks.

Note: These instructions do not apply to DME supplies billed through the outpatient pharmacy program.