Claims and Billing
Determining the Right ICD-10 Code
- Providers can use the NCTracks ICD-10 Crosswalk and the DMA policies to determine the correct ICD-10 code.
- Neither the agents in the NCTracks Contact Center nor any DHHS employee can determine what the right diagnosis code is for any particular situation.
- Only the medical professional who is treating the patient can determine the correct diagnosis code.
The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. For billing information specific to a program or service, refer to the Clinical Coverage Policies.
Time Limits for Filing Claims
Medicaid claims, except inpatient claims and nursing facility claims, must be received by NCTracks within 365 days of the first date of service to be accepted for processing and payment. Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim.
Claims submitted by 5 pm on the cut-off date are processed on the following checkwrite date. Funds are automatically deposited into your account within four days of the checkwrite date.
- The NC Medicaid Program pays claims to the provider’s financial institution using electronic funds transfer (EFT).
- Claims adjudicated for providers who do not have valid EFT information on file will suspend for 45 days awaiting an EFT update, after which they will deny.
- EFT information may be updated on the NCTracks provider portal.
Medical Assistance Finance Section
NCTracks Contact Center
NCTracks Automated Voice Response System (AVRS)