General FAQs

NCTracks is used by the Division of Health Benefits (DHB); the Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMH/DD/SUS); and the Division of Public Health (DPH).

Providers enrolled in DHB, DMH/DD/SUS and DPH health plans may request prior approval or submit claims for payment of covered health care services through the NCTracks Provider Portal, as applicable. NCTracks coordinates processing among the payers to ensure the proper assignment of the payer, benefit plan and pricing methodology for each service on a claim. NCTracks processes health care claims for about 105,000 enrolled DHHS providers who serve over 3 million North Carolina citizens.

The secure NCTracks portal can be accessed by individuals using the Individual or Business North Carolina Identity (NCID) Management-issued user ID and password.

The North Carolina Identity (NCID) Management Service is the standard identity management and access service provided to state, local, business and citizen users by the NC Department of Information Technology. NCID enables customers to achieve an elevated degree of security and access control to real-time resources such as customer-based applications and information retrievals.

 

Individual & Business NCID is for North Carolina residents who need access to online services offered by the state as well as people conducting online transactions with the state on behalf of a business.

 

NCTracks uses the NCID services to enable the State’s Medicaid Management Information System solution and Multifactor Authentication (MFA). More NCID specific information and FAQ’s about NCID are located at https://www.ncid.its.state.nc.us/

The NCTracks Provider Portal provides a secure and convenient method to complete and submit provider enrollment and data maintenance applications.

 

Providers have the ability to complete the application online and to electronically sign and submit the application through the web. The electronic application process also includes the option to upload supporting documents before or after submission of the application.

The NCTracks Provider Portal has been carefully designed with ease of use and productivity in mind. Key features include:

• The option to sign up for NCTracks communications, including announcements related to key program or process changes
• A secure provider Message Center inbox, which informs the user of important information relevant to their record
• Functionality that allows providers to manage changes, update provider records, add services to a location, as well as manage affiliations to billers and organizations.
• Automation of the prior authorization process
• Recipient eligibility verification
• Remittance Advice on-line

All staff who are provisioned to access the provider's record must obtain their own unique North Carolina Identity (NCID) Management-issued user ID and password.

An Office Administrator is assigned to each record and can designate other users for access to the provider record. See the NCTracks Office Administrator, User Setup & Maintenance FAQs for more information.

Our fiscal agent, GDIT, has trained staff in their provider call center and technical help desk to resolve issues. Call center hours are available on the Contact Us link, located on the bottom of any NCTracks page.

Providers can access electronic views of their RA via the secure NCTracks Provider Portal. Providers will also be able to inquire online regarding payment status from multiple NC DHHS payers.

There is a separate section for Carolina ACCESS management fees that includes:

• Rate cohort code and description
• Paid amount
• Number of claims

Yes. The EOBs used to report the disposition of the claims at the detail level are the same ones that appear on the EOB summary page. The EOB summary page is the last page in the RA and lists EOB codes and definitions for all EOBs reported in the RA.

Yes.

If at least one of the detailed lines is paid, the claim header status would reflect the paid status. However, all the detail lines are reported on the RA. The submitted charges on the denied line items are reported but the reimbursement amount will be zero. Also, each line item will have the EOB, edit, and HIPAA error codes that explain why the claim detail item was denied. Non-covered charges are also reflected at the detail level and a total is also provided.

Yes. Line item details are reported on the RA by service dates.

Pended claims are reported separately in the Pend Claims Remittance section of the RA.

Each edit in the new system will map to only one EOB. The EOBs can be mapped to the HIPAA remark codes. There is not, however, a 1-to-1 relationship between HIPAA remark codes and EOBs.

Yes. You can submit an adjustment through the NCTracks Provider Portal or via an 837 batch file. For DMH/DD/SUS providers, only the Local Management Entities (LMEs) will have access to adjust claims on-line.

Prior Approvals (PAs) for physical health services for members in Medicaid Direct should be submitted through the NCTracks Provider Portal. All other PAs must be submitted to the Medicaid member’s health plan. Providers should consult the clinical coverage policy or reference the Prior Approval tab under Providers on the NCTracks website for more information.

Providers can inquire on a prior approval request via the NCTracks Provider Portal regardless of how the request was submitted.

 

Once a decision is reached on a prior approval request, an e-mail will be sent to the provider at the office e-mail address provided. Many types of prior approval requests, particularly pharmacy requests, can be immediately approved by the NCTracks system or by telephone. This means that the provider may receive an immediate approval when a request is received by phone or via the NCTracks Provider Portal.

DMH/DD/SUS providers offering state-funded services must contact the Tailored Plans (Alliance Health, Partners Health Management, Trillium Health Resources, Vaya Health) for prior approval requests.

The PA confirmation number is the number that providers receive to indicate that a prior approval request was successfully submitted to NCTracks. This number is used to inquire on the status of a request via the NCTracks Provider Portal, or when calling fiscal agent staff to discuss a request.