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Provider Updates
These updates support providers by highlighting new classes, trainings, resources, chats, procedures, and programs. You will also find advice and guidance for providers. Subscribe to updates or See Alliance News
04/10/2023
Claims Updates
Split Claims
Professional claims may not contain dates of service that span March-April. If the claim contains dates that span across the transition, the entire claim will be denied.
Institutional inpatient/ED claims with an admission date or “from date” before April 1, 2023, and discharge date or “to date” after April 1, 2023, should be submitted as a single claim to the last payor (i.e., payor in effect on March 31, 2023).
Other institutional (e.g., group home) claims may not contain dates of service that span March-April. If the claim contains dates that span across the transition, the entire claim will be denied.
Replacement Claims
Denied claims many not be replaced.
Approved claims may be replaced.
Site Determination
The site address submitted on the claim must match the site address in NCTracks. This includes Address Line 1, Address Line 2, City, State and Zip +4. The address, along with the billing NPI, will be used to determine the site to adjudicate the claim against.
It is therefore important that providers’ keep their NCTracks info up-to-date and review their claims systems to ensure claims are created with the correct address (mirroring NCTracks).
