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VOL. 1, ISSUE 11 | FEBRUARY 2016
Welcome to the Claims Corner and Eligibility & Enrollment (E&E) Edge from Smoky Mountain MCO. We hope you'll find this monthly bulletin helpful in answering questions about claims and eligibility and enrollment processes. It is our honor to do business with you. For more information, see our Provider Network Bulletin.
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 Denial spotlight: 122 - A specific site could not be determined
Background: A claim submitted through the 837 electronic file lists a site National Provider Identification (NPI) and ZIP+4 matching multiple sites.
What causes this denial? The NPI and ZIP+4 must match a unique provider site location. If multiple matches exist, a specific site cannot be selected and the error is generated.
How do I correct the denial? Always verify the correct NPI and ZIP+4 are listed on the 837 claim. To confirm the information is correct in AlphaMCS, contact Smoky's Provider Network department. Claims may be resubmitted if corrections are necessary.
Need additional help? Our Provider Network department is here for you!
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 Frequently asked claims questions
How do I find out my claims status? Can I contact a claims specialist for this information?
Claims status is provided on a Remittance Advice (RA), which requires access to AlphaMCS for viewing. Claims team members can answer questions about submissions, denials and other general information, but for privacy and security purposes, claims status cannot be provided. To access AlphaMCS, log in through the AlphaMCS Provider Portal. Has my claim paid? What was the amount? To determine when a claim will be processed and which checkwrite/RA it will appear on, refer to the official MCO checkwrite schedule, found on the claims website. The RA will show whether the claim was approved or denied and any payment remitted. For security reasons, claims status or payment information cannot be provided over the phone.
I am an out-of-state provider. Where do I send paper claims?
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Important highlights from recent Medicaid bulletins
 NCTracks: Responding to re-credentialing invitations (January/February)
The Centers for Medicare & Medicaid Services require that all Medicaid providers are revalidated (re-credentialed) at least every five years. This is to ensure that provider enrollment information is accurate and current. The provider's credentials and qualifications will be evaluated to ensure that they meet professional requirements and are in good standing. The re-credentialing process also includes criminal background checks on all owners and managing relationships associated with the provider record.
Every active NCTracks provider must be re-credentialed. However, shortly after NCTracks implementation in 2013, this process was suspended due to the backlog of pended provider Managed Change Requests (MCR). Beginning November 2015, the process was reinstated.
Providers will receive a re-credentialing/reverification letter, or an invitation, through their NCTracks secure portal in-box or e-mail, when they are scheduled to begin the re-credentialing process. This process is completed in the "Status and Management" section of the NCTracks Provider Portal under the section titled "Reverification." A reverification application will only appear when it is time to re-verify. Providers are required to pay a $100 application fee for re-credentialing/reverification.
Re-credentialing is not optional. It is crucial that all providers who receive a notice promptly respond and begin the process. Providers will receive a notification letter 45 days before their re-credentialing due date. If the provider does not complete the process within the allotted 45 days, payment will be suspended until the process is completed. The provider will also receive a termination notice.
If the provider does not complete the re-credentialing process within 30 days from payment suspension and termination notice, participation in the N.C. Medicaid and Health Choice programs will be terminated. Providers must submit a re-enrollment application to be reinstated.
Note: Providers must thoroughly review their electronic record in NCTracks to ensure all information is accurate and up-to-date and take any actions necessary for corrections and updates.
Re-credentialing applies to providers who are enrolled for an indefinite period of time. It does not apply to any time-limited enrolled providers such as Out-of-State (OOS) providers. OOS providers must continue to complete the enrollment process every 365 days.
For questions, contact DMA Provider Services at 919-855-4050.
NCTracks: New Job Aid - How to determine your re-credentialing due date (January)
A new NCTracks Job Aid, How to Determine Your Re-credentialing Due Date, has been posted to the re-credentialing web page on the NCTracks provider portal. As noted in the Job Aid, the re-credentialing due date can be found in the Status and Management section of the secure provider portal 45 days before re-credentialing is due. The Job Aid includes screen shots showing a provider's due date. This Job Aid is a subset of the more comprehensive Re-credentialing Job Aid PRV573, which is available to providers in SkillPort, the NCTracks Learning Management System. More information can also be found on the NCTracks re-credentialing web page.
Effective with date of service January 1, 2016, the American Medical Association (AMA) has added new CPT codes, deleted others and changed the descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2016 edition of Current Procedural Terminology, published by the AMA. Providers should note the full descriptions and all associated parenthetical information published in this edition when selecting a code for billing services to the N.C. Division of Medical Assistance (DMA).
New CPT codes that are covered by the N.C. Medicaid program are effective with date of service January 1, 2016. Claims submitted with deleted codes will be denied for dates of service on or after January 1, 2016. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code.
Billing code update for nurse practitioners and physician assistants (January)
Since the transition to NCTracks, the N.C. Division of Medical Assistance (DMA) has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
DMA has provided instruction to NCTracks on updating the claims processing system. The following procedure code list has been updated recently to include additional NP and PA taxonomies. The newly added codes are:
27822*
27822***
27827*
27827***
90935
96111
96921
*Updated for modifiers 80 and 82 only
***Updated for modifier 55 only
Please note: Codes currently in process for system updates will be published once system modifications are completed. New code problems will be addressed as DMA Clinical Policy becomes aware of them.
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NCTracks update on 1099 tax forms
 On Thursday, January 21, 2016, NCTracks mailed 1099 tax forms to providers using the "1099 Reporting/Pay-To Address" location currently on file for each provider.
2. Fill out all of the required fields on the form and select "1099 Not Received" from the subject drop down box.
3. Enter the mailing address for your 1099 in the message field, then click send.
Allow 10 business days to receive your 1099 in the mail. Please note, this does not correct your address in NCTracks. You must submit a Manage Change Request in the secure provider portal to update your address. Providers are encouraged to update the "Pay To" address on their provider record to correctly indicate where payments and financial data should be sent in the future.
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Categories of Eligibility update
In December 2015, Joint Bulletin #J177 from the N.C. Department of Health and Human Services included an updated DMA Category of Eligibility Table reflecting categories of eligibility currently covered by MCOs under the 1915 (b)/(c) Medicaid Waiver. The following categories of aid were removed and stopped transmitting into the AlphaMCS system on January 11, 2016: HSFNY, MAAMY, MSBBN, MSBBY, MSBCN, MSBQN, MSBQY and MFCGN.
The current list of eligibility codes covered by MCOs under the 1915 (b)/(c) Medicaid Waiver was published on December 11, 2015 and is included below for your reference.
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Category of Eligibility Code
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Category of Aid
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AAFCN, AAFCY
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AFDC - Age 3+
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HSFCY, HSFMN, HSFNN, IASCN, IASCY
| Foster Children - Ages 3+ | |
MAABN, MAACY, MAAMN, MAANN, MAAQN, MAAQY
| Aged - Age 65+ | |
MABBN, MABCY, MABMN, MABNN, MABQY, MADBN, MADCY, MADMN, MADNN, MADQN, MADQY
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Blind/Disabled - Age 3+ through 20
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MABBN, MABCY, MABMN, MABNN, MABQN, MABQY, MADBN, MADCY, MADMN, MADNN, MADQN, MADQY
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Blind/Disabled - Age 21+
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MAFCN, MAFMN, MAFNN, MAFWN
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AFDC - Age 3+
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MFCNN
| Foster Children - Ages 3+ | |
MIC1N, MICNN, MPWNN
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AFDC - Age 3+
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SAABN, SAACN, SAACY, SAAQN, SAAQY
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Aged - Age 65+
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SADBN, SADCN, SADCY, SADQN, SADQY
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Blind/Disabled - Age 3+ through 20
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SADBN, SADCN, SADCY, SADQN, SADQY
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Blind/Disabled - Age 21+
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Enrolled in PHPC
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Innovations
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Client Update Request and substance use target population errors
Some providers have recently reported receiving error messages upon entering a substance use target population on a Client Update Request (CUR). The message states that the target pop already exists, although it is not visible on the CUR or in AlphaMCS.
The issue has been reported and is being resolved. Until that time, we encourage providers to continue entering the target pop on the CUR, noting in the comments box on the front page the target pop entered with the requested effective dates. Once the CUR is approved, the target pop should be visible in the Patient Maintenance Module under the Docs, Assignment tab.
If you need additional assistance, please contact a member of the E&E team at 828-225-2785, ext. 2355.
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Need help?
For claims-related questions, contact your assigned claims specialist via phone or email. If you do not know your assigned specialist, use these general contacts.
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