All Providers Claim Edit for Rendering Provider Service Location

On March 2, 2015, NCTracks claims processing began searching for any active location on the provider record for which the rendering taxonomy code on the claim is valid. The claim is then processed using that location. An Informational (pay and report) Edit 04528 RENDERING PROVIDER LOCATION CODE SET BASED ON TAXONOMY has been posted with Explanation of Benefits (EOB) 04528 on the Remittance Advice (RA). This edit alerts providers to take action to update the rendering provider location on the provider record. Effective Aug. 1, 2016, the claim edit disposition for invalid rendering provider location will change from “pay and report” to “suspend.” Rendering providers must have the addresses of all facilities where they perform services listed as provider service locations under their National Provider Identifiers (NPIs) in NCTracks. When updating a provider record in NCTracks, the MCR will assign a default effective date of the current date to most changes. This is important because the system will edit subsequent transactions against the effective dates in the provider record. For example, claims are edited against the effective date of the taxonomy codes on the provider record. The claim will deny if a provider bills for a service rendered prior to the effective date of the relevant taxonomy code on the provider record.

Source: https://ncdma.s3.amazonaws.com/s3fs-public/documents/files/Medicaid_Bulletin_2016_06.pdf