Reprocessing of Dental Claims Due to CMS Rate Increase

Claims Reprocessing Notice

This reprocessing notice applies to dental claims paid by NCTracks with dates of service between Jan. 1, 2019 through May 2, 2019. Some providers may have affected claims. This communication is being published as a general notice.

Issue: CMS approved a 10% percent rate increase effective Jan. 1, 2019 for dental services. As a result,  claims within the date range referenced above have been identified as underpaid.

Action: The affected claims will be systematically reprocessed as adjustments to apply the rate increase. Please refer to the May 2019 Special Medicaid Bulletin via the following link, https://files.nc.gov/ncdma/documents/files/SpecialBulletin-May-2019-10-Rate-Increase-Dental-Services.pdf.

Timing: Claims will be reprocessed in the Aug. 27, 2019 checkwrite.

Remittance Advice: Reprocessed claims will be displayed in a separate section of the paper Remittance Advice with the unique Explanation of Benefits (EOB) code 10306 – CLAIM REPROCESSED AS A RESULT OF THE CMS APPROVED DENTAL RATE INCREASE EFFECTIVE 01-01-2019. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835).

Important Reprocessing Information: Reprocessing does not guarantee payment of claims.  Affected claims will be reprocessed. While some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were originally adjudicated may apply to the reprocessed claims. Therefore, the reprocessed claims could deny.

If the reprocessed claim denies and there are not sufficient funds to satisfy the full recoupment amount from claims paid in the current checkwrite, an Accounts Receivable (AR) will be created. Recoupment of the AR will begin with the subsequent NCTracks checkwrite and will continue on each checkwrite until the full amount due is recouped.

If funds are insufficient to collect the full amount due from the NPI for which the AR was generated, NCTracks will automatically seek to recoup the AR from other NPIs with the same Internal Revenue Service Taxpayer Identification Number. For more information about the AR process, see the Feb. 29, 2016 announcement.