Tip 1: Filing Claims with North Carolina Medicaid
Submitting claims correctly and on time is essential for timely reimbursement under North Carolina Medicaid billing requirements. The guidance below provides a practical overview of NC Medicaid claim submission rules, filing timelines, payment cycles, and proven billing best practices to help providers reduce denials and avoid reimbursement delays.
Tip 2: Electronic Claims Submission via NCTracks
North Carolina Medicaid billing requires most providers to submit claims electronically through NCTracks, the state’s Medicaid claims processing and provider enrollment system. Although limited exceptions exist, electronic claims submission is the standard and supports faster processing, improved accuracy, and quicker access to claim status.
For billing instructions specific to a program or service, providers should always refer to the applicable Clinical Coverage Policy, which defines covered services, required codes, modifiers, and Medicaid billing rules.
Tip 3: National Correct Coding Initiative (NCCI) and NC Medicaid Billing
North Carolina Medicaid follows the National Correct Coding Initiative (NCCI) to promote accurate coding and prevent improper payments. Providers are responsible for ensuring that all procedure codes comply with NCCI edits as part of standard North Carolina Medicaid billing practices.
For additional guidance, review the National Correct Coding Initiative (NCCI) Fact Sheet (April 2024), which explains common edit types and billing considerations relevant to NC Medicaid claims.
Tip 4: Know the Timely Filing Window
Timely filing is critical for successful North Carolina Medicaid billing:
- NCTracs must receive most Medicaid claims within 365 days of the first date of service.
- Hospital inpatient and nursing facility claims must be received within 365 days of the last date of service listed on the claim.
Claims submitted after these deadlines are not eligible for payment, making early submission a key Medicaid billing best practice.
Knowing your timely filing window allows you to back bill and makes sure you’re getting paid for every eligible claim. If you’re considering back billing, we can help. Click here to schedule a meeting and talk through your options.
Tip 5: Checking Claims Processing and Checkwrites
- North Carolina Medicaid processes claims in near real time, allowing providers to quickly check claim status through NCTracks.
- Checkwrites occur 50 weeks per calendar year.
- No checkwrites occur during:
- The week of June 30
- The week of Christmas
Providers should review the official checkwrite schedules on the NCTracks Providers page under Quick Links to confirm claim cut-off times and payment cycles.
Tip 6: Make Sure You Have Electronic Funds Transfer (EFT) Set Up
All North Carolina Medicaid payments are issued via Electronic Funds Transfer (EFT).
Important reminders for Medicaid billing compliance:
- Providers must maintain valid EFT information in NCTracks.
- Claims submitted without valid EFT details will be suspended for up to 45 days.
- If EFT information is not updated within that period, suspended claims will be denied.
- Authorized provider staff can securely update EFT information through the NCTracks provider portal.
Tip 7: Review Your Remittance Advice (RA) Every Week
The Remittance Advice (RA) is a weekly report listing all claims processed during that cycle, including:
- Payments
- Denials
- Adjustments or takebacks
The RA is the only notification for adjustments to previously paid claims. For example, if Medicaid later recoups a payment due to an audit or billing error, that change will appear on a future RA, even if the original claim was paid weeks earlier.
Review your RA weekly and reconcile it against internal billing records. This allows providers to quickly identify denials, reversals, or partial recoupments before they affect cash flow.
Tip 8: Keep EVV Systems and Authorizations in Sync
Ensure your agency management software and EVV system match the prior authorization (PA) on file with North Carolina Medicaid, including:
- Correct procedure codes
- Required modifiers
- Authorized units
- Approved service dates
Even small configuration errors, such as an incorrect modifier, can trigger repeated Medicaid denials until resolved. Proper system setup is a critical component of effective billing.
Tip 9: Act Quickly on Denials and Adjustments
Do not delay reviewing RA reports; they are essential to revenue protection.
Each week:
- Review new denials and adjustments
- Correct and resubmit denied Medicaid claims promptly
- Investigate all takebacks or recoupments
Fast action often converts a denial into payment and helps providers avoid missing the Medicaid timely filing deadlines.
Tip 10: Don’t Hesitate to Seek Help
If a denial reason is unclear or you are unsure how to resolve a billing issue, seek assistance early. GEOH is here to help you make the billing process easier!
