Issued: March 26, 2019

Claims Processing Edit

Currently, there is not an edit that checks to see if the PR (Patient Responsibility) field has a value or not on an 837P with a COB (Coordination of Benefits). Due to not having an edit in place, the claim will not deny and process through adjudication.

Beginning Thursday, March 28, 2019, claims will deny if the PR (Patient Responsibility) field does not have a value on an 837P when Coordination of Benefits information is submitted on the claim.

If you have questions, please email  or call 704-842-6486.

Reminder for Providers Submitting Update Requests through Alpha

Providers should check the status of all update requests that are submitted through AlphaMCS. Update requests that have errors, are incomplete, or need additional information may be sent back to the provider for corrections.

Any update requests that  arereturned to the provider and not re-submitted by the provider within 14 days will be denied by the AlphaMCS System for timely resubmission.

If you have questions, please email or call Becky Ford at 336-527-3211 or Debbie Eldridge at 336-527-3234.

Discharge Reminders

Providers should submit discharges at least monthly, preferably weekly, using AlphaMCS’s Discharge module for consumers who are no longer receiving services due to:

  • Completed Service(s)
  • Refused Service(s)
  • Moved
  • Transferred Out
  • Are Deceased
  • No Show
  • Or one of several other reasons on the discharge reason drop down

When creating a Discharge, Providers must insert data in all the required fields (areas with a red * asterisk):

  • When the Discharge Reason is “Other” or “Unknown”- comments are required
  • Substance Abuse/Substance Use (SA/SU) – Consumers using SA/SU items – SA fields/boxes are required; (see example below)

Providers should submit billing as soon as possible for all consumers, especially SA/SU consumer(s), to alleviate consumers from being discharged if they are receiving services from multiple providers.

Example – ‘Provider A’ saw substance use consumer for two visits three months ago but did not bill for services until the 88th day after the date of service and are theoretically still seeing consumer. ‘Provider B’ had a referral for the same consumer one month ago, and they refused treatment, so Provider B submits a discharge the week after consumer refused treatment.  In this instance, and because the consumer had no claims submitted within 90 days, a discharge would be processed as a Full Discharge. Full Discharges close out the consumer (their Target Pop, Diagnosis, Insurance & Substance Use Details are end dated). If the consumer presents for service later, a new enrollment will have to be submitted, because they were closed out.

Client Data Warehouse (CDW) requires the LME/MCO (Partners) to process discharge requests for state consumers no longer receiving services so that we will be compliant.  Thus, the reason why Partners requests providers submit timely discharges.

If the consumer is deceased, the provider should submit a date of death (DOD) in the comments.

When consumers are deceased, the primary provider or DSS should notify NC Tracks.

If you have questions, please email or call Becky Ford at 336-527-3211 or Debbie Eldridge at 336-527-3234.