SPECIAL BULLETIN COVID-19 #124: Reprocessing Claims to Apply Retroactive 5% Rate Increase for Medicaid Providers Covered in SL 2020-4

Wednesday, August 19, 2020

The North Carolina Department of Health and Human Services Division of Health Benefits (DHB) is continuing to implement previously-announced temporary 5% provider rate increases to select Medicaid providers (see COVID-19 Special Bulletin #99) to maintain access to care for Medicaid beneficiaries. DHB has identified all relevant claims with dates of service (DOS) eligible for reprocessing to ensure these providers receive the full benefit of the rate increase approved retroactive to March 1 by the North Carolina General Assembly per Session Law 2020-4.

During the weeks of August 10th and 17th , 2020, DHB will begin systematically reprocessing the claims of Medicaid providers in service categories listed in the Medicaid Special Bulletin COVID-19 #99 with DOS from March 1, 2020 through the implementation date of the rate increase for each respective program. 

Due to the magnitude of this reprocessing effort (millions of claims), DHB intends to re-adjudicate claims during the two weeks in August referenced above and through consecutive weekly periods beginning the week of September 6th. and continuing until all affected program claims have been reprocessed. Claims discovered to have issues as a result of this reprocessing effort will be re-examined for resolution and reprocessed in a final designated clean up batch of claims.

Remittance Advice

Reprocessed claims will be displayed in a separate section of the paper Remittance Advice with the unique Explanation of Benefits (EOB) code 10333 - Claims reprocessed as a result of Legislated Mandate of 5% increase effective March 01, 2020 associated with the COVID19 Pandemic.     

The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite (there is no separate 835). Please note that depending on the number of affected claims you have in the identified checkwrite, you could see an increase in the size of the RA. 

Important Reprocessing Information

Reprocessing does not guarantee payment of claims. Affected 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. 

Contact

Provider Reimbursement - 919-527-7699