Reprocessed Nursing Facility Claims with March 2020 Date of Service Range Requiring Provider Adjustments
NC Medicaid implemented a 5% rate increase for Skilled Nursing Facilities effective March 10, 2020 (SPECIAL BULLETIN COVID-19 #32: Rate Increase and Claims Reprocessing). At that time, providers who billed a date span that crossed this effective date were paid the higher rate for the full date span. These claims were recently reprocessed in an attempt to recoup overpayments of billed units with dates of service prior to March 10, 2020.
NCTracks has identified that certain nursing facility claims recently reprocessed with EOB 10354 did not reimburse as expected. To correctly access date-specific provider rate segments, providers should resubmit claim lines with a “From” and “To” date of service that provides a range spanning the number of days (or units) being billed. Please avoid submitting claims with a one-day date span containing multiple units.
For example, when billing for the entire month of March, a claim previously submitted as 3/1/2020 - 3/1/2020 (31 units) should be adjusted to reflect 3/1/2020 - 3/31/2020 (31 units). NOTE: Only the “To” date should be adjusted on the claim. Creating a new claim line will result in a Timely Filing denial. For shorter periods, the units should correspond with the dates on which the service occurred.
Providers who believe a claim did not reimburse as expected should make this correction and submit an adjustment to the reprocessed claim. For your reference, a list of affected TCNs will be emailed to the address on file in NCTracks. If you do not receive this detail by July 31, 2022, or you have questions, please contact the NC Medicaid Provider Reimbursement section at firstname.lastname@example.org.
NCTracks Call Center, 800-688-6696