gdit com NCTRACKS UPDATE Grace Vermeulen Dewey Cassell

gdit. com NCTRACKS UPDATE Grace Vermeulen & Dewey Cassell Health Insurance Institute October 25, 2018

gdit. com AGENDA 1. 2. 3. 4. 5. 6. 7. 8. Previous Changes in NCTracks Recent Changes in NCTracks Upcoming Changes in NCTracks Provider Enrollment: Helpful Tips Re-verification Application Tips Common Questions Provider Resources Q&A

PREVIOUS CHANGES IN NCTRACKS

Previous Changes in NCTracks Billing Provider Address Validation (as of October 29, 2017) ─ ─ ─ 4 | gdit. com Validation of the billing provider address on the claim to an active service location listed on the provider record for the date(s) of service If not matched, the claim will pay and report with the following EOB to give the billing provider time to add the address o EOB 04529 - BILLING ADDRESS SUBMITTED ON THE CLAIM DOES NOT MATCH THE ADDRESS ON FILE The pay and report disposition is temporary. Providers will be notified when the disposition is changed to pend. The provider record can be updated with a new billing provider address by submitting an MCR in the secure NCTracks provider portal Refer to the User Guide “How to Change the Physical Address in NCTracks” Pharmacy and crossover claims and all claims with DOS prior to October 29 are excluded GDIT Proprietary

Previous Changes in NCTracks Updates for MCR, Re-verification, Re-enrollment, & Enrollment Applications: (as of January 28) • The $100 NC Application Fee required for: ─ ─ ─ Initial Enrollment Application for NC Medicaid and/or Health Choice (Note: This includes Out of State (OOS) full enrollment applications) Re-verification Application (every five years) Resubmitted application (withdrawn, abandoned, or denied) MCR to change an OOS Lite enrollment to full enrollment OPR Lite Application • Note: the fee is not required for Re-enrollment Applications or OOS Lite providers 5 | gdit. com GDIT Proprietary

Previous Changes in NCTracks Updates for MCR, Re-verification, Re-enrollment, & Enrollment Applications: (continued) • Changes to Federal Fee Collection and Site Visits Processes for Moderate and High Risk Providers Re-verification Applications ─ MCR to add a new site location ─ Re-enrollment Applications ─ • Federal fee collection and site visit occurs during processing of Application • Federal fee collection now automated • Fingerprint-based background checks are required for High Risk Providers 6 | gdit. com GDIT Proprietary

Previous Changes in NCTracks New Medicare Cards (SSN Removal Initiative) ─ ─ ─ Beginning in April 2018, CMS started mailing new Medicare cards (existing NC Medicare patients should have received them in June) The Medicare Health Insurance Claim (HIC) number is being replaced with the new Medicare Beneficiary Identifier (MBI) Addresses confidentiality and security concern with using SSNs MBI is 11 “non-intelligent” characters in length, numbers and uppercase letters MBI transition period runs through December 31, 2019 NCTracks has launched a New Medicare Card webpage o ─ 7 | gdit. com Includes FAQs, Announcements, and links to other resources Refer to the CMS website for more information GDIT Proprietary

Previous Changes in NCTracks • Notification Period and Subject Line Description for Re-verification/Re -credentialing (as of April 29) ─ Naming of Provider Letters Posted to the Message Center Inbox o Applicable description of the letter in the subject line instead of the letter ID 70 days to submit Re-verification/Re-credentialing instead of 45 ─ Provider portal application displays existing owners & managing employees, allows the provider to edit, end-date, or add in ─ Re-verification due dates no longer extended if an MCR (to update records) is in review ─ o ─ 8 | gdit. com Updates to owners’ and managing employees’ information (address, phone number, email) is incorporated into the re-verification application (no MCR required) A list of providers due for re-verification in 2018 is on the NC Medicaid website GDIT Proprietary

Previous Changes in NCTracks Notification Period for Re-certification (as of April 29) Notifications to update licensure, accreditation, and/or certification now sent 60 days prior to expiration ─ If not updated by the expiration date, participation is suspended for 60 days ─ If not renewed during the 60 -day suspension period, provider is terminated ─ Certifications must be up to date to complete Re-verification/Re-credentialing ─ o 9 | gdit. com Correct NC Medical Board MD/PA/AA licenses and Clinical Laboratory Improvement Amendments (CLIA) certifications updated automatically GDIT Proprietary

Previous Changes in NCTracks New Process to Identify Claim Fraud (as of April 29) • Identify suspicious claims and patterns of activity in order to prevent fraud, waste, and abuse • Claims processing with enhanced evaluation of beneficiary’s date of death, incarceration, and state residency status • Prior to the issuance of any payment to the provider for the claims 10 | gdit. com GDIT Proprietary

Previous Changes in NCTracks New Process to Identify Claim Fraud (continued) • If inconsistencies are found, claims pend for a review period of 20 days ─ EOB 01859 identifying pended claims flagged for review: o CLAIM PENDED WAITING RECIPIENT REVIEW • County staff will investigate the report and update NCFAST/NCTracks as needed ─ 11 | gdit. com After 20 -day review period, claim will be adjudicated based on any updates to the recipient’s eligibility record GDIT Proprietary

RECENT CHANGES IN NCTRACKS

Recent Changes in NCTracks New Application Withdrawal Option (October 8, 2018) • Providers can now withdraw an application instead of sending email or fax • The Withdraw hyperlink is located on the Status and Management page • Prior to withdrawing the application, the system will request confirmation ─ Once confirmation is submitted, the application will be immediately withdrawn • Once withdrawn, an application cannot be pulled back for processing ─ A new application must be submitted, which may require $100 application fee • The electronic withdrawal process pertains to applications that are In process, In review, Pending endorsement, Returned, or Pending payment 13 | gdit. com GDIT Proprietary

Recent Changes in NCTracks Document Upload Capacity Increased (October 9, 2018) • The Upload Documents Page on the Secure Provider Portal now allows providers to upload up to 20 enrollment-related documents instead of 10 • This feature may be of use to: A provider needing to upload documents in support of an affirmative response to an Exclusion Sanction question ─ A provider responding to an email/letter advising that an application is incomplete and additional documentation is required. ─ 14 | gdit. com GDIT Proprietary

Recent Changes in NCTracks AMH Tier Attestation Tool (October 1, 2018) • Advanced Medical Homes (AMHs) are the primary vehicle for delivering local care management as the state transitions to Medicaid managed care • There are multiple AMH tiers ─ Providers will be grandfathered as AMH Tier 1 or Tier 2 providers • Providers may attest to a high tier level using the AMH Tier Attestation Tool • Training is available to guide providers on completing AMH Tier Attestation Instructor-Led Training course; see Sept. 4 announcement to register ─ AMH Attestation Job Aid in Skillport ─ • Attestation is only required if provider wants to qualify for a higher AMH tier 15 | gdit. com GDIT Proprietary

Recent Changes in NCTracks • Radiology Taxonomies Added to 3 D Breast Tomosynthesis Codes • HCPCS codes G 0279 (DIAGNOSTICS DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL) and 77063 (SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS) will be covered when billed by body imaging and other specialized radiologists • Diagnostic Radiology: 2085 R 0202 X • Pediatric Radiology: 2085 P 0229 X • Body Imaging: 2085 B 0100 X • Neuroradiology: 2085 N 0700 X • Diagnostic Neuroimaging: 2085 D 0003 X • Vascular & Interventional Radiology: 2085 R 0204 X 16 | gdit. com GDIT Proprietary

UPCOMING CHANGES IN NCTRACKS

Upcoming Changes in NCTracks Upcoming Releases: • TIN Matching – October 28, 2018 The IRS limits acceptable taxpayer names to Alpha (A-Z), Numeric (0 -9), Hyphen (-), and Ampersand (&), plus no more than two spaces in a row ─ NCTracks validation is being added to ensure that Organization and DBA names don’t have miscellaneous characters ─ o A one-time update will be made to remove existing issues All provider organizations sharing the same Taxpayer Identification Number (TIN) will be updated automatically to report the same taxpayer name ─ Individual providers who report their income to an Employee Identification Number (EIN) will be required to enter a DBA name ─ 18 | gdit. com GDIT Proprietary

Upcoming Changes in NCTracks Upcoming Releases: • Division Name Change – October 28, 2018 Effective Aug. 1, 2018, the Division of Medical Assistance (DMA) and Division of Health Benefits (DHB) combined into one division (DHB) ─ North Carolina Medicaid and NC Health Choice remain the same, and are collectively referred to as “NC Medicaid” ─ NCTracks and the Medicaid website will be updating content, templates and other information over the next few months ─ o 19 | gdit. com Use both terms when using the search function on the Medicaid or NCTracks website GDIT Proprietary

Upcoming Changes in NCTracks Upcoming Releases: • Multi-factor authentication (MFA) – TBD After authentication with State NCID system is successful, NCTracks will perform second factor authentication ─ Users will need to enroll on DIT Website for second factor authentication ─ o Users can select MFA method; either Phone call or Mobile App If second factor authentication fails, contact DIT Call Center for assistance ─ Phased implementation for access to secure NCTracks portals ─ o 20 | gdit. com Phase I: State and GDIT users; Phase II: Providers GDIT Proprietary

PROVIDER ENROLLMENT: HELPFUL TIPS

Provider Enrollment: Helpful Tips • Application Accuracy Site visit & federal fee payment must have been completed with documentation (to another State or Medicare) if you are reporting it has been previously completed ─ NCTracks checks against these records thoroughly ─ • Common Mistakes Incorrect SSN or DOB ─ DBA/facility name instead of legal business name ─ 22 | gdit. com GDIT Proprietary

Provider Enrollment: Helpful Tips • ‘Unknown error has occurred’ message ─ Take a screenshot send it to NCTracksprovider@nctracks. com • NPI is missing from Status and Management ─ 23 | gdit. com May happen because OA has chosen ‘yes’ to PIN access under User Administration GDIT Proprietary

Provider Enrollment: Helpful Tips • Update Provider Enrollment Information Pursuant to Section 6. a. of the NC DHHS Provider Administrative Participation Agreement, providers are required to update their enrollment record(s) in NCTracks within 30 days of a change using a Manage Change Request (MCR) ─ Commonly, affiliation and taxonomy information are overlooked ─ End-date any affiliations that are not current o Make sure physical addresses are correct with the accurate taxonomy o Also update expiring licenses, certifications and accreditations ─ Providers who fail to respond within the specified time limits can be suspended or terminated ─ 24 | gdit. com GDIT Proprietary

RE-VERIFICATION APPLICATION TIPS

Re-verification Application Tips: Accurate Record, Easier Re-verification • Make sure your name, DOB, and SSN are correct! • Submit required documentation prior to submitting a re-verification application • Providers are NOT able to correct this information on initial enrollments, reenrollments, or re-verifications ─ If the error is submitted on an application, provider must withdraw and resubmit it with the correct information • These changes cannot be made using an MCR. Instead, submit via: ─ Fax: 855. 710. 1965 ─ E-mail: NCTracksprovider@nctracks. com 26 | gdit. com o Preferred method GDIT Proprietary

Re-verification Application Tips: Accurate Record, Easier Re-verification • Look for inaccurate accreditations on your record (often not required, entered erroneously, or old information) • If dates for them are expired or become expired, this could stop your application from going through • You must end date them (and enter new accreditations if required) • Submit a written request to the NCTracks Call Center on company letter head requesting to have the accreditation removed if the accreditation is not required 27 | gdit. com GDIT Proprietary

Re-verification Application Tips: Accurate Record, Easier Re-verification • Address Change? • Do not try to correct the location on your record by entering a new address over the old one If you do this, the old service location will be automatically end dated; claims with a date of service after that end date will not pay ─ Add new location, and once all the claims with previous address on them are received, then end date the old location ─ Use correct address and taxonomy that corresponds with the claim’s date of service ─ 28 | gdit. com GDIT Proprietary

COMMON QUESTIONS

Common Questions • Requests for information that’s on the NCTracks provider portal Checking status of PA requests ─ Submitting a PA request ─ Asking what medications are preferred ─ • Individual NCIDs • Referring Recipients to call NCTracks ─ 30 | gdit. com NCTracks can only disclose eligibility and lock-in information to recipients GDIT Proprietary

PROVIDER RESOURCES

Provider Resources • NC DHHS website • Medicaid Bulletins • NCTracks Provider Portal ─ Announcements, FAQs, User Guides, Fact Sheets, Issues List • 2019 checkwrite schedules available under Quick Links on the right side of the provider portal home page • Email List Manager – Provider Communication webpage ─ Make sure your email is correct & subscribed • Regional Provider Relations Representatives ─ Request help using Contact Us link in footer of every NCTracks webpage • Provider Training ─ ─ 32 Instructor-Led (on-site and remote), CBTs, & Participant User Guides More information on Provider Training Page; register in secure provider portal 2017 CSRA Proprietary

Feedback on Presentation • NCTracks Presentation Feedback Survey Name of meeting: HII ─ Date: 10/25/18 ─ Presenters: Grace Vermeulen and Dewey Cassell ─ • https: //www. surveymonkey. com/r/KYWX 88 P • Responses are anonymous and much appreciated 33 2017 CSRA Proprietary

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