Claims and Billing
Rules for Providers Billing Beneficiaries
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.
Billing Codes for Services Previously Denied - Nurse Practitioner, Physicians Assistant and Certified Nurse Midwives
Certain nurse practitioner (NP), physicians assistant (PA) and certified nurse midwives (CNM) services have received denials due to incorrect billing codes since July 2013. NCTracks is updating the claims processing system as inappropriately denied codes are received.
Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code.
The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. Newly identified codes will be addressed as they are received by the DMA Clinical section.
Medical Assistance Finance Section
NCTracks Contact Center
NCTracks Automated Voice Response System (AVRS)