This bulletin applied to NC Medicaid Managed Care and NC Medicaid Direct.
NC Medicaid is aware of the challenges and concerns from retro-enrollment changes, particularly their impact on claims and recoupments. NCTracks identified that retro-enrollment changes were occurring more than two years from the Date of Service. This happens when a member transitions from NC Medicaid Direct (fee for service) to a Managed Care health plan. NC Medicaid is working to resolve the issue both internally and with all providers that may be impacted.
NC Medicaid will assist providers who have experienced recoupments by scheduling their claims for reprocessing within the next 90 days. NC Medicaid is collaborating with NCTracks to make the necessary adjustments. Additionally, NC Medicaid has halted further recoupments. For claims with a Date of Service that is within two years of the original payment date, providers must continue to follow the normal process of resubmitting the claim to the new designated Managed Care Organization.
If you are experiencing financial hardship due to claims recouped by NCTracks as a result of retroactive enrollment in a health plan, we encourage you to request a hardship advance. The hardship advance will be recovered in conjunction with the release of the reprocessed claims.
To request a hardship advance, please email Medicaid.hardships@dhhs.nc.gov and include:
- A brief explanation of the reason for your request
- Your NPI and Provider Name
- A list of claims for service dates older than the two-year retroactive period prior to the NCTracks recoupment
- The dollar amount you are requesting
Note: Claims for service dates within the two-year retroactive period must be billed to the managed care plan and will not be eligible for consideration for the hardship advance.
NC Medicaid appreciates your continued partnership and dedication to serving members.
For more detailed information on handling retro-enrollment changes, please refer to the Retro-Enrollment Fact Sheet.
Contact
For questions, please contact the NC Medicaid Help Center at 888-245-0179 or email at Medicaid.HelpCenter@dhhs.nc.gov.