Billing Requirement Modifications Due to COVID-19 to Expire Three claims processing edits to end with Public Health Emergency
When the end of the federal Public Health Emergency (PHE) occurs, NC Medicaid will be ending the temporary emergency flexibilities implemented in response to the federal government’s declaration of the COVID-19 PHE, including the disposition of three claims processing edits.
Edits 02437 and 02425 – “Service Facility Provider Invalid or Not Active on Dates of Service” and “Service Facility Provider Invalid or Not Active on Dates of Service. QMB Recipient” will change from pay and report to deny. NPI validation will be required once the expiration date of the federal PHE is announced, which is anticipated to be mid-summer. These edits were relaxed during the pandemic to permit any individual practitioner to deliver services at locations not enrolled in NC Medicaid.
Edit 07025 – “Rendering Provider Not Affiliated with Billing Provider” will change from pay and report to deny. The requirement for an individual provider to affiliate with a billing organization will be required once the expiration date of the federal PHE is announced, which is anticipated to be mid-summer. This edit was relaxed during the pandemic to permit any group to bill on behalf of an individual provider delivering services at another location/group practice with which the individual is not affiliated.
Although no firm date for the end of the PHE has been set, we encourage providers to review all NCTracks provider records as appropriate to ensure:
• Individual providers are correctly affiliated to Organizations billing on their behalf.
• Service facility providers reported on claims are actively participating with NC Medicaid.
Providers were notified in March 2020 that the edit disposition of pay and report was a temporary change due to the COVID-19 pandemic. As NC Medicaid begins its return to pre-pandemic policies, providers are reminded to visit the NC Medicaid COVID-19 Guidance and Resources webpage for the latest updates to ensure services may continue to be delivered without interruption.
NCTracks Call Center: 800-688-6696