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Known Issue Tracker

Known Issue Tracker
Issue IDIssueNo. of Impacted ProvidersDate Issue FoundNo. of Days OutstandingEstimated Fix DateInterest Penalties OwedDate ResolvedStatus NameProvider Type NamesCategory NamesResolution
36Alliance working towards synchronizing the Provider Network datastore with NCTracks. During this time claims may adjudicate improperly (Approve vs. Denied).110909/01/202322104/09/2024No04/09/2024ClosedAgenciesClaimsNo provider action needed.
39Claims manually keyed into the portal (CMS1500) as a secondary claim allowed with no PR amount.61209/12/202323404/11/2024NoOpenAgenciesClaims
56Site based claims being approved when the rendering clinician is also set up as a billing provider. The rendering taxonomy is not associated to the rendering NPI.16201/10/20249104/11/2024No04/10/2024ClosedAgenciesClaimsIssue resolved. No provider action required.
57Health plan edits applied to the statement-period-to date opposed to the claim DOS allowing claims to approve during health plan termination/suspension periods.15601/19/20248204/02/2024No04/10/2024ClosedAgenciesClaimsIssue resolved. No provider action required.
58Alliance is updating the adjudication process to process claims under EPSDT from based on prior authorization to EPSDT claim submission.10001/22/202410205/30/2024NoOpenAgenciesClaims
59Claims approving in error when the rendering provider is not associated with the billing provider. When resolved claims will be re-adjudicated to deny under edit 140 "Clinician not associated with Provider."2309/29/202321304/11/2024No04/29/2024ClosedAgenciesClaimsIssue resolved. No provider action required.
60Some claims with a State Benefit Plan are being covered by Medicaid Authorizations. State auths can cover for Medicaid BP claims but a Medicaid auth cannot cover for State BP.4202/16/20247705/30/2024NoOpenAgenciesClaims
61There are secondary COB claims with service lines without PR that are paying the full allowable amount (i.e. more that the PR amount)403/04/20246007/11/2024NoOpenAgenciesClaims
62Institutional claims have historically adjudicated at the service detail level where each DOS of an inpatient claim is validated individually. This is in conflict in how the NCDHHS system edits claims and Alliance is in discussions with the State on the specific requirements and changes to be made.19103/27/20243707/11/2024NoOpenAgenciesClaims
63Professional Claims with a supervising NPI are approving without a Medicaid health plan for the supervising NPI.11004/04/20242905/30/2024NoOpenAgenciesClaims
64Inpatient stay specifically authorized for revenue 0160 is not covering the stay line on the claim as expected with erroneous denial reason 35.2104/08/20242504/23/2024NoOpenAgenciesClaims
65There are certain claims approving where the health plan is not in an Active status, resulting in erroneous payment.111404/02/20243104/30/2024NoOpenAgenciesClaims
66Alliance is not actively enforcing the TCM addon to be billed on the same claim as the TCM service.604/11/20242204/30/2024NoOpenAgenciesClaims
67Alliance has identified issues related to site validation from the Provider Enrollment File where records were being removed or not matching on the full address. We have resolved the issue and reprocessed affected claims. This applies to claims submitted as of date 4/04/2024. As a reminder, providers are required to submit a valid NPI, zip +4 and taxonomy according to their NC Tracks enrollment in order for a claim to process successfully.19904/24/2024905/07/2024NoOpenAgenciesClaims
This page was last reviewed for accuracy on 04/13/2023