Author: NC Medicaid Third Party Liability, (919) 814-0240
NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved. NC Medicaid appreciates the assistance of the provider workgroups to identify issues and confirm improvements once system enhancements were completed. HMS will also continue its other assigned third-party liability reviews.
Providers with overpayments on their accounts should electronically submit adjusted claims to NCTracks. If claims are outside the 18-month adjustment period, refunds should be submitted to NCTracks using the Provider Refund Request Form.
The instructions and the form are on the NCTracks Provider Portal under the “Provider Forms” section at https://www.nctracks.nc.gov/content/public/providers/provider-manuals.html
Please complete a separate form for refunds for NC Health Choice recipients. Mail the completed form along with a check to:
Division of Health Benefits
Medicaid Misc. Payments
P.O. Box 602885
Charlotte, NC 28260-2885
The NC Health Choice form and its refunds must be sent to:
Division of Health Benefits
NC Health Choice Misc. Payments
P.O. Box 602861
Charlotte, NC 28260-2861