Providers are contractually required to submit billing electronically through Partners’ AlphaMCS portal. AlphaMCS is a web-based system that is available to Partners Providers upon completion of a Trading Partner Agreement (TPA).
Providers must submit claims through the AlphaMCS Provider Portal using:
- an approved 837 submission or direct entry onto CMS 1500 forms for outpatient services, or
- UB04 for hospital inpatient/emergency department services.
The AlphaMCS Provider Portal Manual outlines very specific instructions on what is needed to complete a claims form. Details regarding claims submission are available in the Partners Provider Operations Manual.
Inquiries regarding claims status should be directed to the Partners Claims Department staff.
You can contact the Claims Department directly by calling 704-842-6486 or email firstname.lastname@example.org for assistance.
Timeframes for Claims Submissions:
All claims must be submitted within 90 days of the date of service to ensure payment, unless otherwise specified in Provider’s contract. Claims filed outside of requirement will be denied for payment. Claims based on retroactive Medicaid eligibility must have authorization requested within 90 days. Timely filing request and submission of claims must be within 90 days of the date modified in NCTracks for eligibility date range.
Providers may submit replacement claims for originally processed claims within 90 days of the processed date, not to exceed 180 days from day of service. Replacement claims submitted outside these guidelines will be denied due to timely filing requirements. Replacement claims originally denied for timely filing will continue to deny.
Timely Filing Override Requests
Timely filing override requests should only be submitted for the following reasons. The requests are reviewed for consideration.
Timely Filing Requests should be sent directly to email@example.com prior to submitting the claims.
- Retroactive Medicaid: Claims based on retroactive Medicaid eligibility must have authorization requested within 90 days. Timely filing requests and submission of claims must be within 90 days of the date modified in NCTracks for eligibility date range.
- Retroactive Medicare/TPL: If claims are recouped due to retroactive Medicare/TPL, the claim can be resubmitted once the claim has been resubmitted to other insurance. The only exception is claims that are not within the Fiscal Year for State benefit. Timely filing requests and submission of claims must be within 90 days of the date modified in NC Tracks for eligibility date range or date of Partners BHM recoupment.
- NC Tracks License update/addition: Request must be submitted within 30 days of date modified in NCTracks.
- NC Tracks NPI/Taxonomy update/addition: Request must be submitted within 30 days of date modified in NCTracks.
- AlphaMCS system issues identified by Partners.
- Eligibility issue with NC Fast/NC Tracks: Request must be submitted within 30 days of date modified in NCTracks.