The Payment Error Rate Measurement (PERM) audit calculates error rates for Medicaid, Children’s Health Insurance Programs (CHIP) and Managed Care on a three-year cycle for the Centers for Medicare & Medicaid Services (CMS). The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of those three programs in the fiscal year under review.
Note: NC Health Choice (NCHC) is the state’s CHIP program.
This article was updated on May 10, 2018. Topics include: list of providers due for re-credentialing, changes to re-credentialing process, and changes to ongoing verification process.
Registration is open for the March 2018 instructor-led provider training courses listed below. Slots are limited.
In a recent attempt to send an email helping providers with a common error, CSRA noticed that 12.5 percent of the provider email addresses were invalid or unsubscribed. To provide providers with the accurate information they need, it is crucial that NCTracks has a valid email address that is subscribed to the NCTracks Communications email list. This is especially important for targeted emails that apply to specific providers (such as a claim reprocessing notice).
NCTracks encourages providers to:
Effective March 1, 2018, North Carolina Medicaid has revised Clinical Policy 11C, Ventricular Assist Devices
Following a 45-day public comment period, Clinical Coverage Policy 3B, Program of All-Inclusive Care for the Elderly (PACE), was amended and posted on North Carolina Medicaid Community-Based Services Clinical Coverage Policy web page.
Effective March 1, 2018, all North Carolina Medicaid and NC Health Choice beneficiaries must be 12 years of age or older to receive chiropractic services.
Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies, is updated to add policy guidelines for home ventilators with a non-invasive interface and to add HCPCS codes E0466 to the Durable Medical Equipment and Supplies fee schedule as a continuous rental.
At various times of the year, Medicaid providers may receive notification of participation letters from the DMA Office of Compliance and Program Integrity which facilitates audits from various auditing agencies, e.g. Office of the Inspector General, Office of Internal Auditor, and Office of State Auditor.