After more than 90 days of operations, NCTracks processes more than 49 million Medicaid claims

Press release

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.


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0 thoughts on “After more than 90 days of operations, NCTracks processes more than 49 million Medicaid claims

  1. Elisha

    I would like to know if Ms. Byrd works for CSC. This is nothing more than a hyped up publicity tactic and far from the truth about how CSC is really operating!! I work in a large providers office handling the Medicaid accounts and can assure you it has been nothing short of a continuous nightmare. Their customer service reps can answer absolutely no questions, and I am not sure why NC tax dollars are being spent paying these people. They are an overpaid answering system because they only escalate each ticket you call in on and then you NEVER get a call back. Medicaid has also passed an underhanded rate cut on their secondary claims which is illegal, sneaky, and underhanded. This is being challenged by the NC Medical Society and many providers. Their computer system does not work (or only when it wants to), and we cannot get answers for any of our issues. This is only the tip of the iceberg.
    Also, as the mother of two children with Medicaid, let me speak from the recipient point of view. The state is backed up in processing recertification applications. So when they can’t process your application in time, they will drop you. My children’s coverage was dropped suddenly for no reason as of October 1st because they are backed up due to the new system. This is not my children’s fault and one of them requires very expensive medications for a chronic condition that cannot be stopped. I cannot get through to the local department of social services as they are “too busy to take calls at this time”.
    CSC and NC Tracks are a complete nightmare and the providers and patients are the ones paying the price!!!!!

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