New Third Party Liability (TPL) Edit for Pending Automated Collection and Tracking System (ACTS) Policies

Effective June 1, 2025, NCTracks will implement a new Third Party suspect edit related to insurance policies received from Child Support Services via the existing interface with the NC Automated Collection and Tracking System (ACTS) which are potentially subject to medical enforcement. If an insurance policy sourced from ACTS is matched to the Medicaid primary payer claim, then the claim will pend for up to 100 days awaiting policy updates. Claims pending with this new functionality will be identified with the following Explanation of Benefits (EOB):

EOB 02590 – RECORDS INDICATE AN INSURANCE POLICY PRIMARY TO MEDICAID IS ON FILE. The SUPPORT ENFORCEMENT CLAIM WILL SUSPEND FOR 100 DAYS WHILE REIMBURSEMENT IS SOUGHT FROM THE THIRD PARTY.

Existing Third Party suspect editing is unchanged and this new functionality does not apply to pharmacy claims.