Wound care notes with measurements if the recipient has wounds. signed Medication Administration Record, a History and Physical,

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1 NCTracks Questions/Concerns for NCHCFA Convention (including additional questions asked at the convention) February 25, Can NCTracks provide step by step instructions to get FL-2 forms approved the 1 st time submitted? We are getting 1 out 3 approved on the 1 st try. But we are sending same information on all 3. They are inconsistent on the date of approval. In comments section we are requesting retro dates. Sometimes they pick it up and sometimes they don t. A suggestion to NCTracks would be to add a box(field) for effective date of Medicaid. This was available on previous Medicaid vendor. Prior Approval The provider must submit either the Physician s Authorization of Level of Care or FL2 form. Providers must ensure that all the information is completed on the form including the admission date to the facility. In addition, an initial request must include 14 days of medical records starting with the first day they want to get paid. Medical records should include: Nurses notes, Therapy evaluations, Therapy notes, a signed Medication Administration Record, a History and Physical, Wound care notes with measurements if the recipient has wounds and Retroactive approval will be given on the initial PA request as long as the following is indicated on the PA: 1- The admission date to the facility is on the Physician s Authorization of Level of Care (DMA-0100) or on the DMA FL2 (DMA ); and 2- The retroactive begin date is put in the Additional Information section on the PA request; and 3- All required retro PA documentation is mailed/faxed/uploaded with the PA request; and 4- A letter with the specifics of the retro request on it. When requesting retroactive prior approval for a PA that has already been approved, the provider must take the following steps: 1- Upload or fax the Medical records (same as above); 2- Call the call center and ask to create a ticket for LTC Retro request and give the PA number of the PA already approved in NCTracks; and 3- Check NCTracks to ensure the changes were made to the requested begin date. The request will be processed within five business days of receipt of all of the information. Providers are strongly encouraged to use the web portal to upload PAs and additional information rather than mailing or faxing. 1

2 2. When we receive the RA crossover claims, on previous vendor, they included the non-allowed bad debt amount. This is not included NOW. 3. When we print the RA it takes 3-4 pages per resident. On previous vendor you would get several residents on 1 Page. This is a huge waste of paper. 4. During our AR reviews this week, we have discovered another issue with NCTracks. Since the implementation of NCTracks, we have seen an increase in our payments being recouped for overlapping dates with the hospitals. This is affecting multiple facilities and is not specific to one hospital. Often times the overlapping date is the day the resident was admitted/readmitted to our facility. One facility has reported that one of their residents went out to the hospital for a lab; however, our entire claim was recouped for overlapping date of service. Examples of the issue with recoupment of SNF claims that include a discharge date from the SNF and an admit date to the hospital are as follows: a. TCN# Resident discharged from SNF on 11/3/2013. Dates of service 11/1/ /3/2013 were recouped on this TCN#. b. TCN# Resident discharged from SNF on 8/12/2013. Dates of service 8/1/2013 8/12/2013 were recouped on this TCN#. c. TCN# Resident discharged from SNF 11/25/2013. Dates of service 11/13/ /25/2013 were recouped on this TCN#. d. TCN# Resident discharged from SNF 11/28/2013. Dates of service 11/13 11/28/2013 were recouped on this TCN#. Provider Relations Representatives are available to conduct on site visits to help explain how to submit PA s in NCTracks. Click on the Contact Us link in the footer of any NCTracks portal webpage, fill out the contact information and select Request a Site Visit from the Subject drop down list. Financial Based on the requirements and original design agreed upon between State and CSC, the bad-debt amount is not populated on the Paper RA. However, CSC has developed a Bad Debt report, outside of the Paper RA, that will provide this information. Financial The Paper RA is working as designed and agreed upon between CSC and State. Currently, there is no scheduled plan to reduce the size of the paper RA. Priority is being given to issues that affect recipients receiving care and providers getting paid. Claims This issue was fixed on 1/27/14. You may resubmit these claims as new claims. Example f is similar although not a discharge issue. The hospital billed IP claim 3/7/13-3/8/13 causing NH claim Dates of service 3/1/2013 3/12/2013 to be recouped. This is a valid recoup per the hospital claim. 2

3 e. TCN# Resident discharged from SNF 12/10/2013. Dates of service 12/1/ /10/2013 were recouped on this TCN#. f. TCN# This resident did not discharge. She went to the hospital to have a lab drawn on 3/7/2013. Dates of service 3/1/2013 3/12/2013 were recouped on this TCN#. 5. We are currently discussing Medicare Advantage crossover payments. Prior to CSC we actually got paid money for the Medicare Advantage crossover claims. However, we are no longer receiving money for these claims. 6. Providers are given a Checkwrite Schedule with the dates that we will be receiving our money via EFT. My question is if the schedule is provided, then why do we keep getting memos that the EFT will be delayed due to a Holiday? When the schedule is prepared is it unreasonable to think that the persons preparing the checkwrite would consult a calendar? 7. I would also like clarification, it was my understanding that Providers would have access to their RA on the day before the checkwrite. When I am told this, I feel that I should be able to pull up the RA for January 22 when I get to work on the 21st. I realize that I may be mistaken and therefore request clarification. 8. How can I arrange for an NCTracks representative to visit my facility for on-site assistance/training? 9. Two of our main concerns with NCTracks are our Medicare Part A crossovers or 890's. We have tried to mail them in and Claims Medicare HMO claims pay as a secondary claims, not the same process as was done in legacy. See provider announcement posted Oct 7, Secondary claim adjudication logic is as follows: Medicaid Allowable minus Medicare Paid Amount equals the Net Medicaid Allowable. Next, the Net Medicaid Allowable is compared to the Medicare Coinsurance Amount and the lesser of the two is the amount payable by Medicaid. Provider should indicate the amount that they are billing to Medicaid by indicating this information under their value using A3, B3 or C3. The use of the word delay has led some people to believe there was a change in the checkwrite schedule. The checkwrites are being executed according to the approved, published schedule, which can be found under the Quick Links on the right side of the Provider Portal home page. On weeks when there is a holiday, the checkwrite date is simply one day later than usual, which is already reflected in the checkwrite schedule. The notices are published to serve as a reminder that the checkwrite schedule is different on weeks that have a holiday. From now on, any reminders regarding the checkwrite schedule will be worded accordingly. Financial The paper and electronic RAs (835) will be available at the earliest every Tuesday at 8 AM (as long as Monday is not a Federal, State, or a Bank holiday). The latest it will be available is by every Wednesday at 8 AM. There is a Contact Us link in the footer of every NCTracks webpage. Click on the link, fill out the requested information, select Request a Site Visit in the Subject drop down list, and then click Send. You will be contacted by a Provider Representative to schedule a site visit. Claims EOB 890 is no longer provided. If you have recent denials with bill type 217 please provide claims 3

4 they continue to deny line for line. We did not have this issue with the old service. Also when electronically billing a corrected claim that paid incorrectly NCTracks will take back the money already paid for the claim but then pay the same amount again. When billing a 217 for corrected claim the claim is not being corrected. We are a skilled nursing facility and when we have a resident who comes off of a Medicare Part A stay in the middle of the month and we bill their Medicaid for room and board for the remainder of the month, the system does not calculate their PML or "Resource" even when it is on the claim. I have then rebilled a corrected claim and it does not pay correctly either. I do not know how to fix this. Hope that you may be able to help. 10. We continue to have issues with the initial Medicare Part A crossover claims denying for overlapping dates of service. I have been informed that someone at NCTracks is researching this issue. However, I would like for as many people as possible to be aware of this issue. 11. The issue of the 30 day waiting period to recoup overpayments, resulting in interest and penalty charges, should be addressed. We were told on several occasions that it is preferred that providers let overpayments be recouped on the RA rather than mailing in paper checks. We agree if they would recoup the money immediately AND recoup based on NPI number rather than Tax ID number. Instead, they are waiting 30 days to recoup overpayments. After 30 days the money is recouped from the first provider with that Tax ID number which may not be the provider that was overpaid. For a company with several facilities some of which share the same Tax ID number, this makes it very difficult to apply recoupments correctly. Additionally sending in paper checks for all the adjustments/refunds that we submit would be excessive. a. TCN # This was a recoupment claim that processed on the 8/27/2013 checkwrite date for NPI# XXXXXXXXXX. The paid amount was ($2,337.86). The message below appeared at the end of the RA: detail so we can research. Claims Please provide examples showing crossover claims denying against Medicaid claims. Need to determine if a crossover submission issue or a claims processing issue. Claims / Financial Awaiting direction from the State Controller s office. Refunds can be submitted, along with a copy of the relevant page(s) from the RA, to the address(es) in the Contact Information document under Quick Links on the NCTracks Provider Portal home page. There are separate addresses for Medicaid and Health Choice refunds. 4

5 b. ALERT! IF YOU HAVE A BALANCE DUE TO MEDICAID, HEALTH CHOICE, MENTAL HELATH, PUBLIC HEALTH OR RURAL HEALTH AND COMMUNITY CARE, c. * PER NC STATUE 147 THIS BALANCE WILL BE SUBJECTED TO PENALTY AND INTEREST IF ALL THE OUTSTANDING ADJUSTMENT BALANCES IS NOT PAID d. * WITHIN 30 DAYS OF THIS NOTICE. THE PENALTY WILL BE A 10%. ONE TIME PENALTY AND INTEREST WILL ACCRUE UNTIL FULL PAYMENT IS MADE. e. * ADDITIONALLY, IN ACCORDANCE WITH SECTION 10.37A (A) AND (C) OF NC SESSION LAW , IF THIS BALANCE f. * IS NOT PAID WITHIN 30 DAYS, WE WILL INITIATE SUSPENSION OF PAYMENT PENDING RECOUPMENT OF THE AMOUNT INDICATED ABOVE FROM YOUR CLAIMS g. * IF YOU HAVE ALREADY ISSUED A REFUND RELATED TO YOUR MEDICAID, HEALTH CHOICE, MENTAL HEALTH, OR PUBLIC HEALTH OR RURAL HEALTH COMMUNITY CARE, h. * PLEASE DISREGARD THIS NOTICE. i. * IF YOU CANNOT PAY THIS BALANCE WITHIN 30 DAYS, PLEASE CONTACT DMA/DMH/DPH/ORHCC BUDGET TO MAKE ARRANGEMENTS. j. The claim above was carried over on the 9/4/2013 RA for NPI # XXXXXXXXXX. However, there were no paid claims on this RA to offset the recoupment. The TCN number changed to an FCN #. The FCCN # is k. The claim carried over on the 9/10/2013 RA for NPI # XXXXXXXXXX with the same FCN # above. The total payment amount on this RA was $ $196, (more than enough to offset the $2, recoupment). l. The claim carried over on the 9/24/2013 RA for NPI # XXXXXXXXXX with the same FCN # above. The total payment amount on this RA was $240, (again - more than enough to offset the $2,

6 recoupment). m. The payment was finally recouped on the 10/2/2013 RA for NPI # XXXXXXXXXX (a different facility that shares the same Tax ID#). n. I actually took this example to the one-on-one provider meetings that NCTracks held back in November and the rep that I spoke with took this claim to someone in the financial section to review. She later came back and explained to me that the reason this happens is because, by law, they have to allow us 30 days to repay the overpayment. If the balance is not paid within 30 days, the overpayment is recouped based on Tax ID # rather than NPI #. For a company that has over 40 facilities, (some of which share Tax ID #s), this is extremely challenging trying to follow the recoupments. o. We have several recoupments that we have not been able to figure out when the overpayment was applied and to which facility : p. TCN # ($1,242.26) - Recoupment claim that processed on the 10/29/2013 checkwrite date for NPI# XXXXXXXXXX. q. FCN # This appeared on the 12/10/2013 checkwrite date for NPI# XXXXXXXXXX. 12. Another issue is the length of the RAs. For a large facility, it is not uncommon for an RA to be 500 pages long. Although the RA is stored on NCTracks and can be saved to a file, there are times when it is necessary to print the RA. 13. The new NC Tracks system regarding FL2 prior approval has been MAJOR issue at our facility. We had FL2s that were more than 60 days in the system without any movement towards denial or approval. Calls placed to the customer service line were unhelpful. We continued to get told that they had "expedited" the claim and gave us a ticket number. Most times the prior approval dept was unable to get back to us inside of a week. Every ticket we had open would be resolved before we ever received a call back. The system was very confusing and frustrating for the first 5 months because Financial See the response to #3 above. Prior Approval We are sorry that you were having issues with your FL2s and hope that things are going more smoothly for you now. CSC is not aware of a 4 week period that an FL2 could not be entered. Perhaps this was an issue unique to your situation. If it is not resolved or reoccurs, please let us know by calling the call center and reporting the issue. The turnaround cover sheet must be used when faxing additional information to NCTracks, and not the facilities fax cover sheet. If the 6

7 it seemed like NC Tracks did not know what their own system was for submitting the FL2s. At first we just filled out the FL2 online and submitted it. Then we did that plus faxed the FL2 in. Then there was about a 4 week period where we couldn't enter any FL2s because the system was down. It said there wasn't an object chosen in the NPI box, when there was one chosen. No one knew when the system would be fixed. I've had issues with computer glitches before. It didn't take 4 weeks to resolve. Then there was a DMA MD signature page that needed to be faxed in. Half the time the FL2 and signature page apparently were faxed into a black hole because they weren't received but there was no way to check on it to see if it was received (until we received a denial letter and had to call to find out that information). Only at the end of November were we able to get a contact person inside the Prior Approval dept, however, when we faxed the DMA sheet to her on one of the residents, nothing was ever done to complete the approval as we were told would happen. Then she would not answer or return calls to us. It was only after talking with her that day that we were told that we were to fill out the FL2 online and upload the FL2 and signature page. Since finding out that information, things have been a lot smoother. It now takes less than 14 days to receive an approval/denial decision on the FL2s. Also, we still are not able to open the portal with user information. I'm giving a barely satisfied rating because we have been able to get FL2s approved but it was only after weeks/months of persistence on our part to troubleshoot and communicate with staff at NC Tracks and try to figure out the process that no one over there was real clear on to begin with. 14. The main question that I still have is "Medicare Part A Crossover claims". When is the system at NCTracks going to be able to process these claims? We have been sending our claims electronically to Medicare A and they are crossing over the CoInsurance to Medicaid, however, these claims are not being processed. A memo went out advising providers that we would be receiving a 'Report' listing this information and the status of the claims, as I recall, but to date, I have turnaround cover sheet is not used when faxing in additional information, it does appear that documents go into a black hole as you suggest. This happens because without the CSC turnaround document, the system does not know which PA to associate the additional information with. It is critical that this specific form be used and not provider fax forms. This was a major issue at implementation but CSC believes it has been resolved. To avoid this in the future, CSC encourages providers to upload the information directly to the PA rather than faxing or mailing. If you are faxing or mailing and do not have the turnaround cover sheet, please include the NPI on all pages. Claims Refer to the provider announcement posted Oct 7, 2013 for the crossover pricing logic. 7

8 received nothing for my facility. I also received correspondence from Z. Brewer at NCTracks requesting examples of some of my outstanding Medicare A Crossover claims which I sent to him, however, I have never had a reply from him regarding the findings. I will admit that the previous system did have some problems with Medicare Part A Crossover claims and we were allowed to submit "Resolution Forms with Paper claims attached". When the new NCTracks system took over, all of the paper claims that had not been handled by the prior system were returned to us advising us that we would have to submit to NCTracks. We did send some of the paper claims to NCTracks, however, these have yet to be addressed. My greatest concern is that NCTracks is going to DENY payment for timely filing and THIS should never happen because as a Provider, I have done what I was supposed to do and submitted my claims, however, I am receiving no response and NCTracks states that they will NOT accept paper claims. As for the electronic crossovers from Medicare Part A, the representatives at NCTracks have stated in numerous sessions "This is a known defect and we are working on it". This system went into place July 1, There is no reason that this system was not running correctly at the time it went live. When I have said this to previous persons at NCTracks I am told "You don't understand how big of a project that this change was. It involved changing from a system that had been in effect for 35 years and involved the entire state" When I am told this, my response is "This change was definitely not larger than the change that was made from Provider numbers to NPI numbers which involved the entire country and that change was a smooth transition because they had enough forethought to run the two system simultaneously for several months while testing before going live" 15. Providers are made to wait, told that the problems are being worked on, but when a deadline is set for something that is required of a Provider - there are no excuses accepted and no grace period given. If we miss the deadline, that is our fault. But when NCTracks has missed the deadline for having their Comm NCTracks is making a concerted effort to address issues as quickly as possible. Working with the State, priority is given first to issues impacting delivery of service to recipients and second to those impacting payment to providers. 8

9 system running as it should, the Provider is still the one that is at the disadvantage and has no recourse. The Provider is penalized when they miss their given deadlines as well as when NCTracks misses their own deadlines. 16. I also feel that when the checkwrite schedule is made out, the parties that make out the schedule should utilize a calendar. Providers expect that their money will be available as stated in the checkwrite schedule and plan accordingly. Providers should not have to keep getting notices that the checkwrite schedule is being moved because of a Holiday. Holidays such as Christmas and NewYears and always on December 25 and January 1st respectively, therefore, issuing a Remittance Advice dated December 31, 2013 but not depositing the money into the bank accounts until January 2, 2014 should not occur. Deposits must be posted according to the RA date; which in the case of the RA caused Providers to have to post the deposits in December, then carry the deposit as a deposit in transit and make notations and necessary adjustments on their General Ledger since the money was not only deposited in a month other than the month in which the RA was dated, but was deposited in a completely different quarter. 17. I don't know what the answer is, but I do know that in the case of all of the Medicare Part A crossover claims, Medicaid is not going to be making any payment to providers such as myself, however, I am not allowed to show these claims as a Write Off until they appear on the Remittance Advice as being paid at -0- dollars. 18. I am still having issues with the FL-2 s NOT being retro appropriately in NC Tracks and it is indicated on the FL-2. I have called NC Tracks on this issue numerous of times and each time I am told different ways to resolve this issue but NOTHING has worked. 19. I have another claims issue. This is with Part B/HMO claims coinsurance. About two months ago I attempted to bill HMO coinsurance. The claim denied for days/units/procedure codes. I put in a call to NC tracks and got a ticket number but never received a call back. I m still trying to bill these claims The use of the word delay has led some people to believe there was a change in the checkwrite schedule. The checkwrites are being executed according to the approved, published schedule, which can be found under the Quick Links on the right side of the Provider Portal home page. On weeks when there is a holiday, the checkwrite date is simply one day later than usual, which is already reflected in the checkwrite schedule. The notices are published to serve as a reminder that the checkwrite schedule is different on weeks that have a holiday. From now on, any reminders regarding the checkwrite schedule will be worded accordingly. Claims Review the Remittance Advice Fact Sheet on the Providers Portal. With lower of logic processing if the lesser payment calculates to $0 then it will show on the RA in the paid section as $0 Prior Approval Please see answer to #1 above. Claims Refer to the user guide How-to-Indicate-Other-Payer-Details-on-a- Claim-In-NCTracks-and-Batch-Submissions found under Claims Submissions on the Provider User Guides and Training webpage. Within the Claim Filing Indicator area, the Medicare HMO should be entered as insurance indicator code 16. 9

10 but they continue to deny for the same reason. I haven t found a whole lot of direction under the help section or billing manual. Is there any way you can put into contact with someone who might be able to help? 20. In the last couple of weeks I have been getting Letters requesting additional information for residents who already have approved Fl We would like the guidance in correcting some of the old Medicaid crossover problems. We established a committee to hold monthly Accounts Receivable meetings to discuss outstanding accounts which are greater than 90 days old. Since the fall of 2011, we have heard the same excuse time after time from our office managers. This common excuse is that a claim for Part B Crossover has been sent to Medicaid over and over, but they cannot get the claim to even appear on a Remittance Advice at all not as a denied claim nor even a claim in process. Each claim eventually dies as a claim without sufficient documentation to warrant time limit override. If we only heard this statement from one facility, we could certainly not fault the Medicaid program; however, we have heard it from ALL of our nursing homes with Part B Crossover. Our Regional Director of Accounts Receivable Collections went to a seminar to learn the upcoming changes and the statement was made to her by a Medicaid representative that HP Enterprises had fallen so far behind that claims not processed by the end of the day suddenly fall off the desk into a box of no return. Felecia Williams and Eric Rojas (HP Representatives) came to Triad Medical Services on January 29, 2013 and also said claims were behind and gave us no hope for the future. Does this mean that providers were waiting a reasonable time to resubmit for no reason? Even certified mail does not prove exactly which claims were sent and never appeared on a Remittance Advice. We completed another Bad Debt Write-Off this afternoon for this type of example, because NC Tracks gave another 8918 Prior Approval When a provider submits duplicate prior approval requests in NCTracks, it is difficult and sometimes impossible to identify duplicate requests for LTC PA when a client is pending Medicaid eligibility and does not have a recipient ID. This is the reason that providers receive multiple letters on the same recipient. Claims For NCTracks, these crossover claims should be processed electronically. The Time Limit override process is the same as it was in legacy, as far as the documentation needed. An updated version of the form can be found on the Provider Policies, Manuals, and Guidelines webpage. 10

11 Insufficient Documentation to Warrant Time Limit Override. We have no available documentation to prove these claims were mailed to HP over and over, but never appeared on a Remittance Advice. Is this really our last resort? Must the provider be punished again? Are other providers asking for help, as well? Thank you in advance for your support and suggestions. 22. I would like to share with you the on-going problems with NC Tracks. a. Inadequate training b. Unavailability of workers with knowledge of the new system and the ability to solve a problem c. The Turnaround time is too long for an answer d. Approvals through the NC tracks system being denied by Medicaid due to items that they say where never submitted, but was a part of the original approval applications/submission e. Receiving a letter stating to resubmit information, but not receiving the sheet with barcodes that will link the application with the correct person/application/facility etc. f. Being told that you can look up the individual and add information thru the portal and that the information will be reviewed. This is not accurate because we still receive a letter to say that we have not submitted information g. Before, we could call a contact person and talk about the case, but now we do not get any feedback. Prior Approval 11 A. The providers have access to training on the portal and can have a provider relations representative visit the facility to provider more in depth training. The link to the training area on the NCTracks provider portal is See #1 above for how to request a provider relations visit. B. Staff are continuing to receive training and tools are continuing to be developed to assist staff and providers with using the NCTracks system. C. The turnaround time for getting answers providers questions varies. It depends on the number of calls received and the complexity of the situation. D. The turnaround cover sheet must be used when faxing additional information to NCTracks, and not the facilities fax cover sheet. If the turnaround cover sheet is not used when faxing in additional information, it does appear that documents go into a black hole as you suggest. This happens because without the CSC turnaround document, the system does not know which PA to associate the additional information with. It is critical that this specific form be used and not provider fax forms. This was a major issue at implementation but CSC believes it has been resolved. To avoid this in the future, CSC encourages providers to upload the information directly to the PA rather than faxing or mailing. E. CSC is unaware of any issues with the providers not receiving the turnaround cover sheet. If you pull up the prior approval, you can print the turnaround cover sheet. You may find this article helpful: New Features to Update Prior Approval Requests on the Portal

12 23. We recently began receiving a rash number of letters from CSC saying they had requested more information to approve a FL-2 and it was not provided. We did receive one letter on one patient and that information was provided and she was then approved. Since then, we have received three more letters saying the same on the same patient. When I called, I was told to ignore these letters as they were sent in error and the patient was ok in the system. We have received letters now on three other patients and the families are also receiving these letters. Needless to say the families were frantic. Could you please clarify whether anything else needs to be done. 24. How long should a provider wait after entering a PA in NCTracks with a request to retro up to 90 days before Prior Approval Prior Approval 12 Providers now have the ability to add additional information to an existing prior approval (PA) request via the provider portal. To do this, the provider must search for the PA record and view the details. There will be a section on the details page that looks just like the additional information section that is used when a PA request is created using the provider portal. This section on the details page can be used to provide additional information about the existing PA request. Additionally, the providers can also indicate they wish to fax additional information, and a new cover sheet will be presented to the provider. The new cover sheet should be printed and faxed with the additional information so that it is linked to the prior approval request. You can find this article and many other helpful articles by signing up for NCTracks communication s. F. See the answer to E above. G. Providers must call the call center with any questions. There has been a recent improvement made in the call center processes. If the call center associate cannot answer the question, the provider is immediately connected to a person more experienced to answer the question. Please see answer to #20 above. A provider can perform a PA inquiry on the provider portal to check the status of a PA after 5 business days. Once the retroactive request

13 expecting an approval? We have a situation where two requests were entered and retro requested (records were uploaded with request) and when we got the PA approval they were only approved from date of entry for the PA. We called about the retro requests and were given a ticket number and were asked to send in the records again (which we did send in records again). It has been 8 days and still the ticket is open when we called to check, they said they had the records and they were in review. The original PA's were completed on 11/11/2013, PA's were approved on 12/12/2013 without the retro. Will it take another month to receive notice of determination for the retro request? Also, do you have any tips for us that would help expedite this process or how to make sure that info for retro is being used during the PA determination? 25. I would like detailed instructions on how to bill a Medicaid SNF claim when the resident has a LTC insurance policy that pays part of their room & board and Medicaid pays the balance after their patient liability. 26. I was wondering if you could tell me why our Skilled Nursing Facilities are having issues getting PA s when calling customer service if the FL2 was completed by the hospital prior to the recipients admit and/or the recipient had been at another facility before going to the hospital? 27. It s my understanding that NC Tracks is aware of a billing issue that involves residents who are discharged from the hospital and admitted into a nursing facility on the same day. The claim is denied as a duplicate billed day even though the hospital discharge date is not a billable day. A representative with NC Tracks was unable to provide me with a projected fix date for this problem. a. XXXX b. Payer Claim ID: c. Acct#: 2913 d. Claim Status: 12/03/2013 is processed, it will be reflected in the effective begin date on the prior approval on the provider portal. You may call the call center to inquire whether additional information submitted has been received and is attached to a PA request. The call center agent can look at the prior approval and verify for you whether the attachments are there. Also, please see the information provided in the answer to question #1 above for the details on how to request retro/submit documentation. Claims Refer to the user guide How-to-Indicate-Other-Payer-Details-on-a- Claim-In-NCTracks-and-Batch-Submissions found under Claims Submissions on the Provider User Guides and Training webpage. Prior Approval Due to HIPAA regulations, a recipient s information cannot be provider to anyone unless their NPI is on the prior approval. If the NPI of the provider that is calling is not listed on the PA, the call center cannot provide the information. If the hospital knows the name of the facility the recipient is entering, the hospital can add the facility as the Billing/Rendering provider on the PA request. This will allow the NCTracks Office Administrator of the facility to see the PA. Claims Issue was fixed on 1/27/14. If your claim was recouped, you can resubmit as a new claim. 13

14 e. Claim Date of Service: 06/09/ /30/2013 f. Charge Amount: $11, g. Paid Amount: $0.00 h. Adjudication Date: 12/03/2013 i. Category Code: F2 FINALIZED/DENIAL-THE CLAIM/LINE HAS BEEN DENIED. j. Status Code: 54 Duplicate of a previously processed claim/line k. When we called NC Tracks, they indicated that the hospital discharged the resident on the admission date of 6/9/13. Even though the hospital does not bill for that day because it is the discharge date, our claim is being denied. NC tracks acknowledges this as a system problem and states that it being worked on at this time, but we first reported the problem on 10/24/13 and the problem continues. 28. I would like to see if you help me with the issue I've been having with this ticket# CSI101124, I have billed the claim and the county states they have keyed the patient eligible for Medicaid with a $0 pml however when the claim crosses to NC Tracks its shows the patient ineligible for Medicaid and that the patient owes a liability. Henceforth, I'm unable to collect the that has been billed for dates of services 2/2/2013 to 2/13/2013. Please advise how to proceed. 29. I am having issues with the Medicaid X-over claims after the insurance pays Part A and Part B. We have got a few to pay for the Part A, but NC Tracks system will not accept any of our Part B claims. After the insurance pays for Therapy and issues a co-pay NC Tracks is not paying it. We are having issue with Part A x-over claims, when we enter into NC Tracks a Medicare Part A claim, the first one will say duplicate, but it is not. Spoke with Brenda Sutton and she told us that it was the way the Hospital billed with a discharge code. I have talked too several Hospitals and they are saying that NC Tracks does not know what they are talking about. Brenda says that they need to discharge a Resident with a different status code, but the hospital says no. So who is right? The hospital is not going to change because they are afraid that they will lose some Claims CSC receives eligibility file updates daily. The recipient s caseworker will need to update the PML and once updated the claim and eligibility in the system will match. Claims The issue related to patient status codes 50, 51 and 65 was fixed 9/20/13. You may resubmit your previously denied claim. 14

15 money and I really don t blame them, but we need to get our claims paid. 30. I also would like some help on the claims that were never processed by HP Enterprise. The issue is our Nursing Homes Business Office Manager would send the claims into HP Enterprise several times and some of them were sent by Certified mail then they would never show up on a Medicaid RA. I had meetings with HP representatives and was told that they were behind on their claims in the office. Later I went to another Meeting and I was told that they (HP Enterprise) had several boxes of claim that has not been done. Before July 1, 2013, several HP Representatives told us that they were still behind and claims were still in the boxes. I do not think this is fair for us, how will NC Tracks handle this? 31. How is a Skilled Nursing Facility to file claims for Medicare Part B services on residents that receive their Medicaid retroactively? The system doesn t allow us to enter them with the downloaded eobs and process them correctly. The normal process is that Medicaid pays on the mcbcoins with payment and adjustment. All claims are denying and when we send paper we are unable to follow up on them and they do not seem to be processing. The old process was to send paper with a note on a resolution inquiry form stating Special Batch Skilled Nursing Medical Claim. Can we enter them electronic and will there be a detail instruction booklet showing correct adjustment and copays to enter to get the correct payment issued? a. XXXXX b. XXXXX c. XXXXX d. XXXXX 32. What brought the problem to my attention was the fact that our Medicare Bad Debt account was off by about $100,000. My research found that we had not been paid when Palmetto showed payment with a net difference of $100,000. I hope to get the NPR one day this week. The fact that NC Tracks is causing more delays just complicates our problems since it is difficult to determine Claims The provider will need to submit these claims within the NCTracks system. Claims Refer to the user guide How-to-Indicate-Other-Payer-Details-on-a- Claim-In-NCTracks-and-Batch-Submissions found under Claims Submissions on the Provider User Guides and Training webpage. The claims should be filed the same as any other secondary claim. The retroactive Medicaid in the system should not change the way the claim should be processed. Financial Based on the requirements and original design agreed upon between State and CSC, the bad-debt amount is not populated on the Paper RA. However, CSC has developed a Bad Debt report, outside of the Paper RA, that will provide this information. 15

16 exactly what we are due for bad debt. We have spent several days calculating our figures and I was hoping to not have problems with Tracks going forward. I have been doing this 30 years and have never struggled as much with finances to this extent!!! 33. We are currently having an issue with initial Part A claims denying in NCTracks. Example: Resident was admitted to the facility on 9/6/2013 as Medicare Part A and remained on Part A for October and November. When we keyed the crossover claims in NCTracks, the October and November claims processed as paid claims, but the September claim denied for overlapping dates of service. This is not an isolated incident and is occurring in multiple facilities. Will you please check into this matter for us and see if NCTracks is aware of the issue and; if so, when will it be resolved? 34. Another issue with NC Tracks, we are getting return calls on Saturday from calls we are placing during our business hours Monday-Friday 8:30-5pm. This Saturday it was a call from xxxx at 8:30am and 8:48am returning a call from the previous week to my bookkeeper. Our voice mail specifically states our business hours. How are we to make our staff available to this, do we give them personal cell phone numbers? 35. Double collection of the June 2013 personal monthly liability: For the month of June 2013, the monthly patient liability was collected by HP when they processed the claims for the first half of the month. When the claims for the second half of the month were processed by NCTracks, the PML was collected a second time. Attempts by providers to adjust the PML amounts on the claims have not been successful. 36. Medicare Part C crossover claims: Under the legacy HP system, these were filed on paper. The new NCTracks system was intended to be an electronic system that did not use paper claims. NCTracks informed us that any claims more than 1 year old need to be submitted via paper-these have been submitted at least a half dozen times and we still have not received payment. Claims less than a year old need to be keyed into NCTracks but are still not processing for payment. All claims submitted to HP were never processed. Claims Need to see a specific example to answer appropriately. Claims? No, our representative will not need to have personal cell numbers for your staff. The representative who maybe calling after hours should leave their name and phone number so if you need additional information about the details of the call or have any further questions for this person you may call them back. Claims In this case the provider should void their claim and rebill the claim in which only one PML will be deducted from the claim. Via NCTracks this can be submitted as a replacement claim. Claims Refer to the user guide How-to-Indicate-Other-Payer-Details-on-a- Claim-In-NCTracks-and-Batch-Submissions found under Claims Submissions on the Provider User Guides and Training webpage. Within the Claim Filing Indicator area the Medicare HMO should be entered as insurance indicator code 16. Do not submit these claims on paper, as was done with the legacy system, or they will be returned since they can be submitted electronically. 16

17 37. Claims submitted with a 214 type of bill are denying as overlapping. 38. I just found out through staff s interaction with an NC Tracks rep that when there is a recoupment of Medicaid $, Medicaid does not want us to send in the $, they will just subtract the amount from a future remittance advice; all quite normal. But then our accounts receivable supervisor said what actually happens is that Medicaid waits 30 days to recoup the amount, and then charges us a 10% penalty! Outrageous! How do we get this fixed? 39. How do we file for time limit override. NCTracks advised that I would need to contact DMA. I have spoken with several people at DMA but none seem to have answers. Claims Bill type 214 indicates last claim. Need an example of history claim which is causing this claim duplicate. Claims / Financial The recoupments are applied based on how the recoupments are set up in the system, as per the business rules provided by the State. For example, if NCTracks pays $100 to a provider and the following week, the provider submits a void or an adjustment to the claim then, the $100 will be recouped after 30 days. Due to which, the penalty and interest will be applied since it was recouped after 30 days. This recoupment process is based on the design and approved business rules as provided by the State. Providers can file for Time Limit Override using the Medicaid Resolution Inquiry Form on the NCTracks Provider Portal at Claims, RAs, and all related supporting documentation must be included. The mailing address is on the form. 40. Need instruction to file current Part C crossovers. Claims Refer to the user guide How-to-Indicate-Other-Payer-Details-on-a- Claim-In-NCTracks-and-Batch-Submissions found under Claims Submissions on the Provider User Guides and Training webpage. Within the Claim Filing Indicator area the Medicare HMO should be entered as insurance indicator code 16. Do not submit these claims on paper, as was done with the legacy system, or they will be returned since they can be submitted electronically. 41. The amount of time between tickets being addressed and resolutions is still a huge gap. We just got a call yesterday on a ticket more than 30 days old. It is difficult to hurry up and wait when they still cannot resolve the issue when they call back. The rep was going to send the ticket on up the ladder so we have to wait. 42. We need more detailed explanations of where to send paper claims when they are requesting these. We have been sending to a general address but don t have any idea how the process works once mail is received. 43. If the FL2 has been approved for 30days on NCTracks, are we able to upload medical records requesting the FL2 to retro back the additional needed days or do we have to fax it in? 44. Why when we submit an FL2 with medical records and put a note in the comments section requesting 90 day retro are we Claims or Provider Relations? Can depend on which operational unit the ticket was sent to and what information was contained in the ticket. Claims Please only send claims on paper if using one of the forms, such as Time Limit Overrides, under the Provider Policies, Manuals and Guideline tab. The address to submit the claim to is located on the form. Prior Approval Prior Approval Information can be uploaded to the PA after it has been submitted. See # 22 E above for additional information. You should not have to resubmit the medical records. See #1 above for what records are required. 17

18 having to re-submit the medical records? 45. Are the claim denial codes online on NCTracks? There is an EOB Code Crosswalk to Standard HIPAA Codes on the NCTracks Provider Portal at Coordination of Benefits. When the recipient has a benefit Claims Please make sure that the correct insurance indicator is being chosen for skilled care with their secondary insurance our claims and that the insurance is noted correctly on the recipients file. are not paying because NCTracks thinks they have a primary insurance to Medicaid when the other insurance only pays for skilled care and we are billing for custodial care. 47. If a duplicate FL2 is submitted (because there was no reply to the first one), the recipient s family gets a certified letter saying the FL2 is denied, even after the initial FL2 is approved. A duplicate FL2 should not trigger a denial letter. 48. There have been multiple instances where a recipient had other insurance that is no longer active, the DSS has been updated, but the information is not picked up by NCTracks. 49. Some recipients have private insurance that pays when Medicare is primary, but Medicaid won t pay because they have private insurance. 50. The first address attestation in the MCR works fine, but there are other addresses you cannot get past in the MCR (and no attestation for them) 51. Recoupments do not necessarily take place against the same NPI on the original claim. NCTracks appears to start at the top of the list of NPIs that have the same Tax ID and recoup its way down the list. 52. There are numerous instances in which the recipient s caseworker has updated the PML, but the information is not showing up in NCTracks 53. What should a provider do with claims that were originally submitted to HPES, but never processed? The Time Limit Override process does not apply. Is CSC going to process them? NEW FROM HERE DOWN Currently researching this issue. Please send example(s) through Sam Clark. Please send example(s) to Provider Services Unit at DMA Please send to TPL Unit at DMA Currently researching this issue. Please send example(s) through Sam Clark. The recoupment process is based on the design and approved business rules as provided by the State. Please send example(s) to Provider Services Unit at DMA No. CSC cannot process them and will return those paper claims. Providers with original claims that were submitted to HP but never processed should send them to the DMA Claims Analysis Unit. (Use the same Medicaid Resolution Form as used for Time Limit Overrides) 54. I have not received my Bad Debt Report. The Bad Debt Report is sent at year end, which varies by provider. If your year end has passed and you did not received a report, please NCTracksprovider@nctracks.com. Put No Bad Debt Report 18

19 55. Does Medicare accept the Bad Debt Report as sufficient supporting documentation? 56. If there is information missing from the PA, it takes days to receive the letter with the barcoded turn around document. In the meantime, there is no status on the portal to indicate that there is information missing from the PA request. Financial Unit in the title and the body of the and include your NPI and contact information. Yes, Palmetto has issued a statement indicating they will accept the Bad Debt Report Currently researching this issue. 57. What is the normal turnaround time for an FL2? The target turnaround time for processing an FL2 is 5 business days. 58. DSS only gets PA/FL2 information on a weekly basis and they Will discuss this with the State. don t have access to the PA information on the NCTracks portal. 59. Medicare requires discharge days and non-covered days, but Medicaid does not pay if they are included 60. On Medicare Advantage crossover claims, they are denying for days/units. Providers have been told to leave off the Medicare paid amount and the claims will pay, but that is not in the manual. They have also been told condition code D7 will override Medicare. What should they do? 61. The checkwrite RA date and the EFT payment date are different, which causes problems posting when it crosses a month. (Checkwrite is at end of one month and EFT is in the next month) Why are they different? 62. We are not ever getting a call back from s or tickets logged by the Call Center 63. How are we supposed to handle refunds? The documentation on the portal says not to send a check, but NCTracks does not recoup the money until after 30 days, at which point you owe a penalty for not sending a refund. Could you void the claim instead of sending a check? Why doesn t NCTracks take the money back in the next checkwrite? How do we appeal the penalty? There should This is a policy issue set by DMA. Currently researching this issue. Please send example(s) through Sam Clark. The checkwrite schedule was reviewed and approved by the State. As of July 1, 2013, it is required that there be 50 checkwrites per year, instead of the previous checkwrites per year, so there will occasionally be instances in which the checkwrite date is in one month and the EFT date is in the following month. There has been a recent improvement made in the call center processes. If the call center associate cannot answer the question, the provider is immediately connected to a Tier II person more experienced to answer the question. We are also endeavoring to handle call backs in a more timely fashion. Refunds can be sent to the addresses listed in the Contact Information document under Quick Links on the NCTracks Provider Portal home page. There are separate addresses for Medicaid and NCHC refunds. Providers should include copies of the relevant documentation and page(s) from the Remittance Advice, as well as the refund check. 19