Claims and Billing

Health Plan Billing Guidance

• NC Medicaid Managed Care Billing Guidance to Health Plans

Rules for Providers Billing Beneficiaries

• Rules and exceptions for providers billing beneficiaries

Filing Claims

The North Carolina Medicaid program requires providers to file claims electronically (with some exceptions) using the NCTracks claims processing and provider enrollment system. For billing information specific to a program or service, refer to the Clinical Coverage Policies.

National Correct Coding Initiative (NCCI)

•  National Correct Coding Initiative (NCCI) Fact Sheet - April 2024

Time Limits for Filing Claims

Medicaid claims, except inpatient claims and nursing facility claims, must be received by NCTracks within 365 days of the first date of service to be accepted for processing and payment. Medicaid hospital inpatient and nursing facility claims must be received within 365 days of the last date of service on the claim.

NC Medicaid has checkwrites 50 weeks of the calendar year – no checkwrites occur the week of June 30 and the week of Christmas. Claims are processed in real time. Please refer to checkwrite schedules available on NCTrack's Providers page under Quick Links for cut-off timing for submitted claims.

Claims Payment

• The NC Medicaid Program requires provider claims payments to be by electronic funds transfer (EFT).
• Claims adjudicated for providers who do not have valid EFT information on file will suspend for 45 days awaiting an EFT update, after which they will deny.
• EFT information may be updated by authorized provider personnel using the secure NCTracks provider portal.

Billing Codes for Services Previously Denied - Nurse Practitioner, Physicians Assistant and Certified Nurse Midwives

Certain nurse practitioner (NP), physicians assistant (PA) and certified nurse midwives (CNM) services have received denials due to incorrect billing codes since July 2013. NCTracks is updating the claims processing system as inappropriately denied codes are received.

Note: Certified Nurse Midwives are also called Advanced Practice Midwives and bill under that taxonomy code.

The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. Codes currently in process for system updates will be added to this list, in red, once system modifications are completed. Newly identified codes will be addressed as they are received by the NC Medicaid Clinical section.

Previously Denied Billing Codes for NP, PA and Certified Nurse Midwives

National Provider Identifier (NPI)

Third-party Insurance

Contact

NCTracks Contact Center
Customer Service Agents are available to answer questions at this toll-free number: 
Phone: 800-688-6696. Calls are recorded to improve customer satisfaction.

NCTracks AVRS
The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone.
Phone: 800-723-4337