Author: GDIT, (800) 688-6696
This article is a reminder to providers of the process for submitting requests for Disproportionate Share Hospital (DSH) data. Medicaid and NC Health Choice Providers must request and obtain batch Medicare DSH Recipient Eligibility Verifications and Provider Statistical and Reimbursement (PS&R) reports through NCTracks.
Hospitals or their designated representative are not able to manually submit Medicare DSH eligibility verification and claims data requests to the North Carolina Department of Health and Human Services Medicaid program for dates that fall outside of what NCTracks can produce, as there is no longer a process in place to support these requests.
PS&R Reports
Hospitals will receive PS&R data from NCTracks by submitting a CSRA PS&R Detailed Report Request Form located under the heading Provider Forms on the Provider Policies, Manuals, Guidelines and Forms page of the NCTracks provider portal. The form includes information regarding the cost of the report.
Eligibility Verification
Hospitals will receive recipient eligibility verifications from NCTracks through the X12 270 Transaction Method, at no cost.
X12 270 Transaction Method
Hospitals with a large volume of recipient eligibility verifications should submit batch uploads in the X12 270 transaction format. For information on how to format these files, refer to the 5010 ASC X12 TR3 national standard guidelines. Unique requirements for NCTracks can be found in the 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide located on the Trading Partner page of the NCTracks provider portal.
Providers who submit X12 batch uploads are considered to be “trading partners” and are required to be authorized to submit electronic transactions in NCTracks. For more information on how to obtain authorization to submit electronic transactions, refer to the “How to Select a Billing Agent and Other Claim Submission Options in NCTracks” user guide under the heading Provider Record Maintenance on the Provider User Guides and Training page of the NCTracks provider portal. Additional information may be found in the NCTracks Trading Partner Connectivity Guide on the Trading Partner page.
Hospitals may also use a clearinghouse or billing agent to submit the X12 270 transactions on their behalf.
Providers with questions can contact the GDIT Call Center at 1-800-688-6696 (phone); 1-855-710-1965 (fax) or NCTracksProvider@nctracks.com