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Providers trained on new NC Medicaid billing system

Posted August 1, 2013
Updated August 2, 2013

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— More than 400 medical providers in North Carolina attended a training seminar in Raleigh on Thursday to learn how to use a new statewide billing system for Medicaid called NCTracks.

Some providers attending the session said the state owes them as much as $130,000 in claim, since the $480 million system was rolled out to users on July 1.

NCTracks, which replaces a 35-year-old computer system, uses different identification numbers for various products and services than the old processing system, and the billing software some providers use isn't compatible with the new numbering system.

That is forcing providers to manually enter claims into the state system one by one instead of submitting dozens in a single batch.

Another issue keeping providers from getting paid is that they have not updated their electronic fund transfer information in the new system.

"We just feel like this could have been better implemented, because, if we don't have money to pay our staff, we can't provide a service for our patients," said Teresa Oudeh, an administrator at Oudeh Medical Plaza in Dunn. "We just think it's unreasonable and outrageous."

The North Carolina Department of Health and Human Services predicted a rough transition when it launched the NCTracks, but spokesman Brad Deen said he's not sure what could have been done differently.

The system has processed claims totaling about $38 million for approximately 900 providers without any problems, he said.

New Medicaid claims system puzzles providers New Medicaid claims system puzzles providers

Prior to launching NCTracks, DHHS held training seminars across the state from April to June. At the Raleigh session, about 20 people attended.

"We sent emails. We sent individual letters. We held training sessions, which were lightly attended," Deen said. "The only thing to do is what we’re doing now, which is to bring people up to speed."

In recent weeks, DHHS has set up a call service center for providers, some of whom have said they have had to wait hours on the phone only to find that the service representative doesn't have an answer for their questions.

"When you call to get answers, they cannot provide you with the correct answer," said Christy McCartney, with Triangle Physicians for Women in Cary. "Every time you call, you get a different answer. So the folks who are supposed to tell us what to do, don't know what to do."

Since then, DHHS has hired more staff and extended call center hours.

It also has put in place a response team of 20 people to identify and reach out to providers not getting paid to resolve the problems.

Deen said DHHS is also planning future seminars across the state, but he couldn't say when.

"We are doing everything we can to make sure people have the information they need to file claims successfully and get paid," he said.

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  • edmarc49 Aug 5, 2013

    dagmudos, I also suspect that the big hospitals have been paid,and that only independent practices have not been. There also was a similar decision when DHHS decided to pay the Pharmacies first, then the doctors, dentists and DME the next week,ie, so BIG corporations like CVS would not have a shortfall but other people with less resources would. "Let them eat cake" is now let them eat cookies apparently in NC!

    I am sorry that you are closing down, I hope that you reopen soon. This is precisely what can happen to people who work with Medicaid receipents, and it is not fair. The situation needs to be rectified ASAP, no excuses. Just terrible for this to happen.

  • dagmudos Aug 5, 2013

    edmarc49 is right! The ancient Hammuarabic code this program computer code is written in takes forever to fix or correct, and as a rural provider whose practice will close on the 15th of this month this is utterly frustrating. Another thing I have noticed, has anyone heard from Wake, Rex, Duke, UNC Hospitals or their affiliates complain about this new system? Maybe I am a conspiracy theorist but it just seems odd all of the interviews seem to be independents practices.

  • edmarc49 Aug 2, 2013

    One of the big problems with this system is that the code is written in an antiquated code called Cobal, and only people in India still train in it, so people here in the US with knowledge of it are limited. So, they probably can't fix all that is wrong, which is a scary thought. CSC should have never kept this contract, it was known they could not do the job the first time it was time to change over,yet 200 million more was given to them on top of the 238 million already spent. Why it was so important to change to this Virginia company when HP was doing a decent job is a mystery, and why the State Auditor's report detailing potential disaster was ignored is a mystery too. Patients are being hurt and practices may close because of this, it is a serious matter. People need health care and access, and this NC Tracks mess could make that much harder for ill patients. Doctors closing have to be replaced and do not think that a PA or nurse can do it, that is nonsense.

  • edmarc49 Aug 2, 2013

    There are plenty legitimate claims by providers that need to be paid, that stuff about fraud is a smokescreen. Most of the fraud is not through the physician or dentist claims, more like equipment and Home Health claims. If a primary care doctor submits a claim coded for arthritis, and the patient also has Xrays Medicaid pays for that prove arthritis, and the patient then sees a specialist for arthritis to schedule surgery through Medicaid, guess what, that is a LEGITIMATE claim that should have been paid,cause the patient has an actual problem that is being treated. Medicaid has ample proof that many claims are legitimate by seeing the tests,meds,consults etc ordered by the Doctor. This new stupid system is preventing thousands of legitimate claims from being paid to hard working doctors and that is ridiculous. It is also preventing patients from getting medicatons and tests approved, and impacting their health. There is no excuse for this System failure at all.

  • shagman1947 Aug 2, 2013

    I don't see a problem with the new system. It's good they just can't rubber stamp these claims. That's been the problem with the system in which fraud is rampant. If only 50% of the fraud was eliminated with the filing system, Medicare would have plenty of money to meet the needs of the people of North Carolina. These health care providers have had their cake and eat it too with the stream line system to collect Medicare claims money, much of which was not justified. Maybe they can eliminate the waist now.

  • tickedoff321 Aug 2, 2013

    Kathy is absolutely correct. We have been trained. All of our billing is pending and they don't know why. They've looked at what we've submitted and agreed that it's correct. BUT THEY CAN'T FIX WHATEVER IS WRONG. Many providers aren't going to make payroll and many of us are at the point where we have to turn away Medicaid and HealthChoice consumers. Come on Deen and come on WRAL. It's not a stupid training issue. It's an incompetent government issue! This would never be tolerated in the private sector, but I guarantee you that all DHHS employees will be paid on time.

  • kathymtobias Aug 2, 2013

    Stop by our Facebook page for help from other users. https://www.facebook.com/groups/289420327868685/
    This article appears to say we were not properly trained. I find it hard to believe. We were properly trained. Last Sunday they deleted the DRAFT functions, which will not allow us to do our jobs the way the state policy tells us to bill. We also lost a minimum of 40 man hours because they deleted the drafts we had already entered into the system this has NOTHING TO DO WITH TRAINING!!!!! Also it appears Mecklenburg County news stations are reporting more of the problems you barely hear anything on here. Where are the dentist office you have interviewed? Where are the people who sent in there EFT information and they lost it, we have done our jobs.

  • edmarc49 Aug 1, 2013

    To whatelseisnew: Please stop saying that stupid comment about not taking Medicaid and Medicare patients! That is the height of callous stupidity! These people are not going to disappear and I salute providers trying to serve these sickest patients despite the financial hardship inflicted by the Federal government and now NC Medicaid. No one is going to stop seeing these patients in a snap decision and that would not suddenly make money owed magically appear in a bank account if they did drop those patients. And if a doctor DID drop all Medicaid patients, where are the immediate numbers of Private Insurance patients to replace the Medicaid or Medicare patients now dropped? It does not work like that! Anyone doing that will be out of business quickly..

    Those complaining are CORRECT that the state had no business inflicting this system on the patients and practices and pharmacies. Practices did what they were told to get ready, NC Tracks is the problem, not the practices.

  • whatelseisnew Aug 1, 2013

    Actually, it easily could have been much better. The old codes versus the new simply required a middleware translator app that could have taken the old numbers and mapped them to the new codes. For a very long time now IT has created products that enable disparate systems to interoperate. This is not a new problem and it shows me, the designers of the new billing system did an incomplete analysis of the needs. Of course, no matter how good a job was done, problems would have occurred, but it could have been much less severe.

    To those complaining, well you have an obvious solution. Don't take Medicaid patients. I wish every provider would stop taking Medicaid and Medicare so we can rid ourselves of those two horrible programs. Of the two Medicare is simply an outright SCAM of the public, but both of these programs have been big contributors to the rise in the actual costs of health care to the people that are not in those programs. It annoys me how much the Government scammed from me

  • ExhaustedCPhT Aug 1, 2013

    This whole switch over has been a complete hassle. We were consistently asked if we were ready, when all the while the state should have been getting ready. When trying to call to find information on prior authorizations and so forth for patients, you have hold times of multiple hours. When you finally get a person, they have to switch you to somebody else, who in turn has no idea what is going on. At this point in time pharmacies do not even know if they are getting paid. It appears that there has been no payment for the past month, and we are expected to rebill thousands of claims. There is not enough man power or time in the day to perform these tasks. There are patients that need their medications, and should not have to wait several weeks due to a new system that is inadequate to fulfill their needs! The folks in office are not the ones that have to look at these folks in the face and see their pain! Frustrated does not even begin to explain where we stand today!!

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