Affiliation Claim Edit delayed until Feb. 2017

One of the requirements associated with NCTracks is that attending/rendering providers must be affiliated with the billing providers who are submitting claims on their behalf. The disposition of Edit 07025 has been set to “pay and report” since NCTracks went live on July 1, 2013. The “pay and report” disposition means that claims where the attending/rendering provider is not affiliated with the billing provider will not deny, but Edit 07025 and EOB 07025 will post on the provider’s Remittance Advice (RA). The intent was to alert providers to situations in which the affiliation relationship does not exist. This allows the attending/rendering provider to initiate a Manage Change Request (MCR) to add the affiliation to the provider record. Effective Feb. 6, 2017, the claim edit disposition will change from “pay and report” to “suspend.” Once the disposition is changed, a claim failing the edit will suspend for 60 days. If the affiliation relationship is not established within 60 days, the claim will be denied. Providers must correct any affiliation issues immediately.

Source: https://ncdma.s3.amazonaws.com/s3fs-public/documents/files/Medicaid_Bulletin_2016_10.pdf