Author: Provider Services
Note: This article was previously published in the September 2017 Medicaid Bulletin. It is republished with updates regarding edit disposition.
Effective Oct. 29, 2017, the NC Department of Health and Human Services (DHHS) validates through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider address, city, state and zip code (first five digits) on all North Carolina Medicaid and NC Health Choice claims must match exactly with the corresponding information on the provider record. (The match is not case sensitive.)
Note: It was previously announced that the claim would pend for 60 days. The edit was implemented with a “pay and report” status. Providers receive an informational Explanation of Benefits (EOB) 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE.
NCTracks uses the address submitted on the claim (837 D, P, and I - Loop 2010AA / ADA Dental – box 48, CMS-1500 block 33 and UB04 – Form Locator 1) to match to a service location address on the provider’s record. If NCTracks cannot match the billing provider’s address to an active service location in the NCTracks provider’s file, the provider receives the informational EOB code 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE on the paper Remittance Advice (RA).
This EOB indicates that the provider should add or correct the billing provider address on the provider’s record in NCTracks or correct the address submitted on the claim.
Providers identified with EOB 04529 will be sent a notification via email. Provider records can be updated with a new billing provider address by submitting a Manage Change Request (MCR) in the secure NCTracks Provider Portal. Alternatively, providers can correct the billing provider’s address on the claim so it matches a service location on the billing provider’s record and then refile the claim.
Note: MCRs may be subject to credentialing and verification. For guidance on submitting an MCR, refer to the User Guide, How to Change the Physical Address in NCTracks, in SkillPort.
The edit disposition of pay and report is temporary. Providers will be notified when the edit disposition will change to pend. Once the disposition change to pend occurs, the claims pended with EOB 04529 will automatically recycle daily, so if the provider adds the correct address to the provider record, the claim will resume processing. If the provider does not add the correct address to the provider record within 60 days, the claim will be denied.
Claims with dates of service prior to Oct. 29, 2017, are not subjected to the edit. Pharmacy and crossover claims are also excluded from the edit. Providers with questions can contact the CSRA Call Center at 1-800-688-6696 or NCTracksprovider@nctracks.com.
Provider Services
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