Infant Toddler Program Claims with TPL

When an Infant Toddler Program (ITP) service is denied by a third party payer as non-covered, providers are encourage to submit the claim electronically to Medicaid for processing. The claim should be submitted electronically with a copy of the Third-Party EOB uploaded as an attachment through the NCTracks Provider Portal. The Third Party EOB must include an explanation of the action reason codes.

ITP claims previously paid incorrectly would need to be refiled as an adjustment.

Electronic adjustments are the preferred method to report an overpayment or underpayment to NC Medicaid. There are two separate actions that may be filed:

- A provider should use "void" when he/she needs to cancel or submit a refund for a previously paid claim. The entire claim will be recouped under the void process.
- A provider should "replace" a claim if he/she is updating claim information or changing incorrectly billed information. This term is interchangeable with adjusting a claim. The entire claim will be recouped and reprocessed under the replacement process.

Adjustments can be filed on paper, following the instructions outlined in the Claim Submission section on the Provider User Guides and Training page of the NCTracks Provider Portal. (See link below) However, filing adjustments electronically will facilitate more accurate submission and expedite their processing.