Attention: Hospital Providers Hospital Outpatient Claims Audits Resume

NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved. NC Medicaid appreciates the assistance of the provider workgroups to identify issues and confirm improvements once system enhancements were completed. HMS will also continue its other assigned TPL reviews.

Providers who have identified overpayments on their accounts should electronically submit adjusted claims to NCTracks. If claims are outside the 18-month adjustment window, refunds should be submitted to NCTracks using the Provider Refund Request Form.

The instructions and the form are on the NCTracks Provider Portal under the “Provider Forms” section at www.nctracks.nc.gov/content/public/providers/provider-manuals.html.

 

Mail the completed form along with a check to:

Division of Health Benefits

Medicaid Misc. Payments

P.O. Box 602885

Charlotte, NC 28260-2885

 

Please complete a separate form for refunds for N.C. Health Choice recipients. The N.C. Health Choice form and its refunds must be sent to:

Division of Health Benefits

N.C. Health Choice Misc. Payments

P.O. Box 602861

Charlotte, NC 28260-2861

 

If you have any questions, contact NC Medicaid Third Party Liability at 919-814-0240.