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    • October 25, 2017

    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... more

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    • October 25, 2017

    A PA request may be voided in NCTracks for several reasons. The reason a PA request was voided will now be available in the details of a PA inquiry performed through the secure provider portal. The void description will help providers understand why the PA request was voided, so they can determine how to proceed.

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    • October 25, 2017

    N.C. DHHS will add to NCTracks four new data validations during the entry of prior approval (PA) requests through the secure provider portal. Currently, these data validations are performed after the PA is submitted in NCTracks, which results in the denial or void of a PA record. Adding the validations to PA entry will inform the provider of the... more

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    • October 25, 2017

    The NC Division of Medical Assistance (DMA) is suspending the new Medicaid secondary claims editing related to Claim Adjustment Reason Code (CARC) 97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated) that was communicated in the May 2017 Medicaid Special Bulletin.... more

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    • October 25, 2017

    N.C. Medicaid has drafted a new medical policy outlining the requirements and limits for drug testing for opioid treatment and chronic pain management. N.C. Medicaid held a stakeholder meeting in October 2016 and reviewed the comments, concerns, and suggestions shared by providers at that time. The new policy mirrors Palmetto Local Coverage... more

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    • August 29, 2017

    The NC Department of Health and Human Services (DHHS) has released a detailed proposed program design for transforming the state Medicaid and NC Health Choice programs to managed care. DHHS issued its proposed program design to ensure stakeholders have an opportunity to comment on managed care specifics. Comments are being accepted through... more

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    • August 29, 2017

    The NCTracks Enrollment Team is receiving a significant number of incomplete Manage Change Request (MCR) and Enrollment applications from providers. Examples of common errors include: Supporting documentation not attached, Incomplete Exclusion Sanction information and Choosing the incorrect taxonomy code. Errors like the ones cited above delay the... more

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    • August 29, 2017

    N.C. Session Law 2013-360, subsequently modified by Session Law 2014-100, required a 3 percent rate reduction in 10 Medicaid and N.C. Health Choice services. The 3 percent rate reduction for physician services was implemented March 1, 2015, for current claims and going forward. The rate reduction was applied to most previously paid claims over... more

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