Upon Go Live: Replacement MMIS Benefits to the NC Provider Community
NCTracks, the new multi-payer claims processing system that replaces the Legacy Medicaid Management Information System (MMIS), will have easy-to-use features to support electronic processing of various queries and transactions such as recipient eligibility verification, prior approval requests, claims submission, personalized secure email messages, and electronic Remittance Advice reports. The NCTracks system incorporates many of the benefits of state-of-the-art technology designed to maximize paperless processing and increase the provider’s administrative efficiency through utilization of the advanced features of the new system.
Provider Personalized Web Portal
The provider will have the capability through the Portal to manage aspects of their business with the replacement system. The enhanced functionality will allow providers to more efficiently manage changes, update record(s), add services to a location, participate in electronic communications and listservs, as well as manage affiliations to billers, groups and organizations. The functionality will allow for the automation of the Prior Approval (PA) process, checking recipient eligibility, check-write information, Remittance Advice’s (RA’s) and most functions that are today performed only through the Automated Voice Response System. Most of the automation accessible by the provider will allow for real-time processing and information retrieval. The Portal will serve to enhance providers’ access, productivity and management of their information, and will expedite business processes that are not automated today.
Providers will be able to participate in web-based tutorials, register for class seminars and request site visits through the Portal. All training materials will be available for retrieval and downloading.
Providers will be able to establish and manage staff access to their records, use electronic signature capabilities and upload documentation to further streamline and reduce time-consuming paper processing.
NCTracks General Web Portal
Enroll as a Provider
The NC Tracks Web portal will provide a secure and convenient method to complete and submit initial provider enrollment applications.
Providers will have the ability to complete all required fields on application web pages, electronically sign and submit the application. The electronic enrollment process also includes the option to upload supporting documents with the initial application.
Providers can choose to complete and submit the enrollment application in one session or multiple sessions by saving the application to later retrieve, complete and submit when all information is complete.
The NCTracks Web Portal will also provide a secure and convenient method to complete and submit periodic re-credentialing applications and updates. NCTracks pre-populates the provider's most recent data on file. The provider will have the ability to validate and update his or her information, electronically sign and submit the required forms.
Update Provider Enrollment Information
The NCTracks Provider Web Portal will enable providers to update their demographic and other pertinent data. Providers can retrieve, view, and update enrollment information through a “Manage Change” request. NC Tracks pre-populates the provider’s existing data on file, enabling verification and update to specific information, authorization by electronic signature, and real-time submission for processing.
Check Application Status
A provider will be able to log in to the NCTracks Portal to check the status of a new application, re-credentialing application, or enrollment change request.
Recipient Eligibility and Enrollment Verification
The NCTracks Portal will allow providers to inquire about recipient eligibility for a single date or a span of dates. Providers can also submit an online “mini-batch” to obtain eligibility information for up to 25 recipients in a single transaction.
The response will include information on recipient eligibility, managed care enrollment, third party insurance coverage, cost sharing, service limits, hospice, pharmacy lock-in, and transfer of assets.
Electronic Claims Submission
The NCTracks Portal will allow for the submission of all claim types including pharmacy. Claims can be entered and submitted for processing online, allowing providers immediate access to initial processing results. Previously submitted electronic claims can be retrieved at a later date if necessary for updates and resubmitted as adjustments or void transactions.
Prior Approval Inquiry and Request
Providers will be able to create and submit most PA requests with attachments as electronic documents, as required, via the web portal. Providers will also have the ability to determine if a specific service or procedure requires prior approval.
NCTracks will continue to support the processing of paper PA forms. Providers submitting paper PA forms will still be able to check the status of any PA request via the Provider Portal, after the paper document has been scanned, imaged, and indexed for document control and tracking purposes.
Claims Payment Status and Electronic Fund Transfer
NCTracks will fully support electronic funds transfer (EFT) for claims payment. The EFT enrollment process has been streamlined to simplify and expedite the activation timeframe for the initial EFT payment. Providers sign up for EFT at enrollment and the system will automatically send a test transaction to the bank to verify the information submitted. All subsequent payments to the provider will be made using EFT.
NCTracks remittance and status reports (RAs) have been re-designed based upon suggestions and recommendations received directly from providers. Remittances will be easier to follow and include simplified language of claim denial reasons. There will be a one-to-one correspondence of claims edits to EOB codes, and claims will be fully adjudicated through the majority of system edits and audits to reduce multiple claim denials for different reasons upon each re-submission.
Providers will have access to electronic views of their remittance reports via the secure NCTracks Portal. Providers will also be able to inquire online regarding payment status from multiple payers (DMA, DMH, DPH, and ORHCC).
Electronic remittances will be available in an ANSI X12 835 format.
Provider Training and Workshop Enrollment
NCTracks will expand the training options and methods available to ensure providers have quick and easy access to training information and materials. Providers will have web access to customized web-based learning modules for in-office staff training opportunities. Web-based module(s) and supplemental training materials for the session will be available for a variety of topics including general orientation, claims filing instructions, special areas of interest, and NCTracks training. Provider manuals, bulletins, and training workshop schedules will all be available online, including the capability to enroll for training workshops through the Provider Portal. Providers will also be able to submit on-site visit requests via the NCTracks Web portal.
Additional NCTracks Features
Automated Voice Response System (AVRS)
Providers will be encouraged to take advantage of the breadth of functionality available through the new NC Tracks Portal, but there will also be a variety of capabilities available through the enhanced and redesigned AVRS. The voice navigation menu has been modified to direct callers more efficiently through the various options to obtain desired information, including:
- Claim status;
- Checkwrite;
- Prior Approval for DPH benefits;
- Medicaid and NC Health Choice eligibility and service limits including:
- Managed care enrollment information, including the primary care provider name, address, and daytime and after-hours phone numbers;
- Third party liability;
- Medicare coverage;
- Well-child checkup dates;
- Co-payment requirements; and
- Hospice eligibility.
Callers will have the option to speak directly to a Customer Call Center agent if the information needed is not available through the automated response options.
Summary
The State and CSC have partnered to bring a comprehensive provider business solution to the Replacement MMIS. The foresight gleaned from beneficial meetings with the provider community during previous endeavors, as well as lessons learned, have tremendously assisted with Replacement MMIS efforts thus far. The Department will continue to partner with providers to ensure that the provider community embraces the outcome. Providers’ utilization of system improvements and enhanced business processes will solidify our partnership as, together, we progress in this and other efforts to advance data access and sharing.
