Medicaid Secondary Claims Where Cost Share Does Not Apply, and Contractual Obligations Reporting on Medicaid Secondary ClaimsShare

N.C. DHHS will implement in NCTracks new business rules for processing Medicaid secondary claims and claim adjustments where a Third-Party payer made a payment on the claim and Cost Share (Patient Responsibility) was not applicable. Specific coordination of benefit (COB) payer filing indicators will identify Third Party claims that will price without Cost Share. This new method will apply to X12 837 Institutional, Professional, and Dental claim transaction types (837I/P/D) as well as claims keyed into the secure provider portal.