Author: Third Party Liability
Medicaid’s Third-Party Liability (TPL) contractor, Health Management Systems, Inc. (HMS), will implement a Commercial Insurance (CI) Disallowance project to streamline North Carolina’s coordination of benefits and direct billing processes.
The expected date for implementation is Oct. 1, 2018. This will result in higher recoveries for the state and higher pay rates for providers. HMS assists Medicaid providers by identifying and validating other (non-Medicaid) health coverage so that providers can maximize payment rates by billing commercial rates rather than Medicaid rates.
The CI Disallowance process will be like the Medicare Disallowance projects that have been operational in North Carolina for more than 10 years. HMS will validate policy coverage for all claims selected for CI disallowance to mitigate unnecessary work on the part of providers, loads the data into our Provider Portal and then initiate the CI disallowance billing cycle.
To prepare for this change, HMS will be offering webinars to outline the process in detail, as well as provide an opportunity for providers to ask questions. There will be separate webinars for Institutional Providers and Professional Providers. Register by clicking on the titles below:
- CI Disallowance Overview (Hospitals)
- Aug. 7, 2018 – 10 a.m.
- CI Disallowance Overview (Physicians)
- Aug. 9, 2018 – 10 a.m.
Providers with questions should contact HMS North Carolina Provider Relations at 1-877-260-0270.