Children’s Developmental Services Agency Providers Carved Out of Managed Care The following services should continue to be billed through NCTracks
Due to the passage of SL 2021-62, effective July 1, 2021, the following services are carved out of NC Medicaid Managed Care and should continue to be billed through NCTracks:
- Services documented in an individualized family service plan (IFSP) that are provided and billed by a Children’s Developmental Services Agency (CDSA)
- Services documented in an IFSP that are provided and billed by a provider contracted with a CDSA to provide those services.
CDSAs and independent practitioner providers providing IFSP services for the CDSA should hold their claims from July 1, 2021, through July 12, 2021, for dates of service starting on July 1, 2021.
Starting on July 13, 2021, CDSAs and independent practitioner providers providing IFSP services for the CDSA may submit their claims to NCTracks for all IFSP services for dates of service starting on July 1, 2021. These claims must be submitted to NCTracks with a TL modifier.
NC Medicaid is temporarily waiving existing PA requirements for CDSAs and independent practitioners who provide ISFP services on behalf of the CDSA starting on July 1, 2021. More information will be added when PA requirements are reinstated.
Providers are required to maintain records related to services consistent with the clinical coverage policy 8-J. Additionally, providers should be prepared to submit PA requests when the PA requirement is reinstated. All claims are subject to audit.
For beneficiaries enrolled in NC Medicaid Managed Care, please note that other services, provided by independent practitioner providers, which are not IFSP services still must be billed to the prepaid health plan (PHP) with whom the beneficiary is enrolled. The PHPs may request additional information to validate that the services are not IFSP services.
NCTracks Call Center, 800-688-6696