Author: Provider Reimbursement
As previously communicated in the December 2017 Medicaid Special Bulletin, Reimbursement Rate Increase, North Carolina Medicaid retroactively increased the rate for Personal Care Services (PCS) and the Community Alternatives Program for Children (CAP/C).
Medicaid will initiate a systematic reprocessing for applicable PCS claims for dates of service Aug. 1, 2017 through Dec. 31, 2017, in the April 24, 2018 checkwrite.
An additional reprocessing notice will be sent through the NCTracks provider portal for those providers directly affected.
Reprocessed claims will be displayed in a separate section of the paper Remittance Advice (RA) with the unique Explanation of Benefits (EOB) code 10400 - CLAIM ADJUSTED FOR PCS RATE CHANGE. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)
Reprocessing does not guarantee payment for the claims. Applicable PCS claims will be reprocessed. While some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were originally adjudicated may apply to the reprocessed claims. Therefore, the reprocessed claims could deny.
Providers with claims for date of service Aug. 1, 2017 through Dec. 31, 2017, that billed $3.47 and were paid $3.47 will not be reprocessed during the systematic reprocessing. Submit replacement claims to receive the increased reimbursement. Providers are advised to bill their usual and customary amount.
Providers with questions regarding the approved rate increase may contact Medicaid’s Provider Reimbursement Section. Those with questions regarding the submission of replacement claims can contact CSRA at 800-688-6696.
Provider Reimbursement
DMA, 919-814-0060