New Process for Crossover Claims without Medicare Coverage

Effective May 1, 2017, NCTracks will implement a new edit that will impact all crossover claim types (inpatient and institutional Medicare part A; professional, outpatient and institutional Medicare part B). Medicare part C claims will not be affected by this implementation. The new edit will identify crossover claims (excluding Medicare part C) that indicate a Medicare payment yet no Medicare coverage is present for the recipient in NCTracks. The new edit that will be displayed to providers is “Explanation of Benefit (EOB) 01710 – NO MEDICARE ON FILE. Claims that meet this criterion will suspend and will recycle daily for sixty days awaiting the addition of Medicare coverage to the recipient eligibility file.

Source: https://www.nctracks.nc.gov/content/public/providers.html