Reminder: Credit Balance Audit and Quarterly Reporting Requirements

All providers participating in the Medicaid program are required to submit a quarterly Credit Balance Report to the NC Medicaid Third-Party Recovery Section indicating balances due to Medicaid.  Providers must report any outstanding credits owed to Medicaid that have not been reported previously on a Credit Balance Report.  However, hospital and skilled level nursing facility providers are required to submit a report every calendar quarter even if there are no credit balances.  The report must be submitted no later than 30 days following the end of the calendar quarter (March 31, June 30, September 30 and December 31).

The Medicaid Credit Balance Report is used to monitor and recover “credit balances” owed to the Medicaid Program.  A credit balance results from an improper or excess payment made to a provider.  For example, refunds must be made to Medicaid if a provider is paid twice for the same service (e.g., by Medicaid and a medical insurance carrier, by Medicare and Medicaid, by Medicaid and a liability insurance policy), if the patient liability was not reported in the billing process, or if computer billing errors occur.

In conjunction of completing the report, a Credit Balance is the amount determined to be refundable to the Medicaid program.  When a provider receives an improper or excess payment for a claim, it is reflected in the provider’s accounting records (patient accounts receivable) as a “credit.”  However, a Credit Balance includes money due to Medicaid regardless of its classification in a provider’s accounting records.  

If a provider maintains a Credit Balance account for a certain period (e.g., 90 days) and then transfers the account or writes it off to a holding account, this does not relieve the provider of liability to the Medicaid program.  The provider is responsible for identifying and repaying all money owed to Medicaid.

The Credit Balance Reporting process is an electronic process. Health Management Systems (HMS) has completed the development of the Self-Disclosure Portal in its eCenter web application. The application will process Credit Balance Reports more quickly and efficiently. The application will also benefit providers by reducing the cost for postage and paper. Once the report has been uploaded it will receive a time and date stamp as evidence of submission by the provider.  In order to submit Credit Balance Reports electronically, each provider will need to register to use the Self-Disclosure application in eCenter.

1. Navigate to HMS eCenter: ecenter.hmsy.com
2. If you have never used eCenter, please click on the link “Start here for new access”
   1. Fill out the registration form and click submit
   2. You should receive a follow- up communication from HMS Help Desk. Please inform the

Help Desk that you need access in eCenter to the “Provider Portal Provider Overpayment Reporting-NC”

3. If you are a current user in eCenter, please call the HMS Help Desk at 855-554-6748 to request that your access be updated
   1. Inform the Help Desk that you need access updated in eCenter to the “Provider Portal Provider Overpayment Reporting-NC”

Submitting the Credit Balance Report does not result in credit balances automatically being reimbursed to the Medicaid program. You will need to indicate the refund method of your choice -- whether you file a replacement claim, mail a refund check with the NCTracks Provider Refund Form or request that NC Medicaid adjust the claim on your behalf. A provider-submitted adjustment to the claim through NCTracks is the preferred method of satisfying the credit balance refund requirements. If you would like NC Medicaid to make the adjustment on your behalf, please make sure you report all cost share and overpayment amounts correctly.

Failure to submit Credit Balance Reports will result in the withholding of Medicaid payments until the report is received.

Instructions (2045) and the formatting (2044-ia) for the quarterly credit balance report are located on NC Medicaid’s Website at:https://medicaid.ncdhhs.gov/providers/forms/third-party-insurance-forms