The federal Public Health Emergency (PHE) is expected to end on May 11, 2023. At that time, NC Medicaid will return to pre-pandemic policies related to the claim edits referenced below.
Providers were notified in March 2020 that the claims edit disposition of pay and report was a temporary change due to the COVID-19 pandemic. Beginning with date of service May 12, 2023, NC Medicaid will end the temporary emergency flexibilities implemented for the disposition of three claims processing edits. The affected edits include:
- 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” was changed to “pay and report,” effective with date of processing March 13, 2020.
- These edits were relaxed during the pandemic to permit any individual practitioner to deliver services at locations not enrolled in NC Medicaid.
- Service Facility NPI validation will be required with the expiration of the federal PHE.
- The “pay and report” will be set to “deny.”
- Edit 07025 – “Rendering Provider Not Affiliated with Billing Provider” was changed to “pay and report,” effective with date of processing March 13, 2020.
- 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.
- The requirement for an individual provider to affiliate with a billing organization will be required upon expiration of the federal PHE.
- The “pay and report” will be set to “deny.”
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.
Contact
NCTracks Call Center: 800-688-6696