Most importantly, DMA has dropped its proposal to require all referrals of Medicaid patients by primary care providers (PCPs) in the CCNC/CA networks to be arranged manually and exclusively via the NCTracks portal beginning Nov. 1, 2016. In addition, DMA is eliminating the current requirements that:
- PCPs must first receive a CCNC/CA authorization (via portal, phone, or otherwise) from NCTracks before referring to any specialist;
- the rendering-specialist must include the NPI of the patient’s PCP on his/her claim for the claim to process and pay; and
- rendering-specialists must request overrides/exceptions by phone if the authorization was not done in advance or there was some related problem.
The umbrella issue of “managed care referrals and overrides” is the highest-volume and longest-running complaint the North Carolina Medical Society (NCMS) has received involving Medicaid since NCTracks came online in 2013, so this is a welcome change.
DMA is hosting a series of training webinars to review these changes, as well as some new claims-processing rules known as the “ordering, prescribing, and referring (OPR) edits.” View the list of webinars beginning on page three of the special bulletin.