From the North Carolina Department of Health and Human Services:
Raleigh, N.C. – After 90 days of operations, DHHS and its vendor, CSC, continue to proactively assist providers with utilizing the State’s new Medicaid claims payment system, NCTracks. To date, NCTracks has processed 49 million claims and paid more than $2.6 billion to North Carolina healthcare providers.
“While we predicted this would be a rough transition for both the State and North Carolina’s 77,000 Medicaid providers, we will not be satisfied until every provider is successfully utilizing the new system,” said Joe Cooper, DHHS Chief Information Officer. “We recognize that challenges remain and some providers are still struggling. DHHS and CSC continue to put all available resources towards proactively reaching out to providers to assist them with this monumental transition to a new claims payment system.”
Before the new Medicaid claims payment system NCTracks went live on July 1, DHHS told healthcare providers to expect delays and glitches because of the size, scope and complexity of the system.
Cooper explained that problems with an already difficult transition were exacerbated by the call center not being staffed to handle the initial high call volume. The NCTracks Call Center received up to 6,000 calls daily with high abandon rates and wait times of up to an hour or more, leaving many providers frustrated and without answers. CSC added additional call center staff and today, the average wait time is less than 15 seconds to speak with a customer service agent.
“We have been making rapid improvements to the NCTracks customer service and support experience to better address provider questions,” Cooper added. “We have also been working proactively with associations of providers and provider groups to help them transition to the new system.”
Since go-live, DHHS and CSC have taken a proactive strategy to assist providers using NCTracks. DHHS and CSC:
Increased staffing at the call center to help inbound callers with questions.
Created SWAT teams charged with proactively reaching out to providers having the most difficulty with the transition.
Established response teams to address technical issues as swiftly as possible.
The State has issued hardship advances to many providers still struggling with the transition. To date, 144 providers (or 0.1% of all providers) have received $65 million (or 0.2% of all payments to date) in advance hardship payments. Almost all of the hardship advances have been recouped by the State because providers are now successfully submitting claims using NCTracks.
The single biggest issue keeping providers from getting paid remains taxonomy, the system of medical codes that NCTracks uses to determine whether a provider has the proper credentials to bill for the item or procedure on a claim. To assist providers with taxonomy issues, DHHS and CSC continue to hold additional training, both in-person across the state and online, as well as proactively reaching out to providers, associations and third-party billing agents to walk them through the steps necessary to successfully process claims and ultimately get paid.
Immediately after go-live, 60% of rejected claims were because of incomplete or missing taxonomy codes. Presently, that percentage is down to less than 15%.
Cooper explained that while the transition to NCTracks has been bumpy as expected, the new system includes many improvements for North Carolina healthcare providers. NCTracks pays providers more often and providers know the status of their claims almost immediately after submitting them. The system will also promote information sharing and efficiencies by consolidating several other aging computer systems in Public Health, Mental Health and Rural Health, which will:
Decrease the likelihood of fraud and abuse by making available more provider, recipient and claims data.
Improve operations for the state, providers and recipients by switching providers from a paper to a digital submission process. (At least 57 forms have been eliminated.)
Accelerate processing/adjudication times.
Improve cash flow. (Providers will be paid 50 times a year, almost weekly; up from 42.)
Provide for electronic submissions for claims, prior authorization, enrollment, inquiry options, and attachments – saving money and time.