CHARLOTTE, N.C. — Channel 9 took concerns and complaints that came into our newsroom directly to the state. Eyewitness News asked DHHS spokesperson Ricky Diaz specific questions based on interviews, emails and calls from medical providers.
Our questions and his responses are below.
Question: Has the state identified glitches or errors in the NCtracks system?
Answer: Yes, as we expected, we have found a few glitches in a transition of this size and complexity. We transitioning both from a 35 year old system and to a taxonomy-based system. Overall NCTracks is has processed nearly 9.3 million claims in the last checkwrite. In talking with other states who have made similar, successful transitions of their claims processing systems (like GA), they all note that there are two primary sources of interruptions during the first 60-90 days: expected technical issues that come up and a learning curve for users. We continue to work on a 24/7 basis in the first weeks of operations to prioritize and tackle any technical and performance issues as they are found and work closely with healthcare providers, associations and societies to help them submit claims.
Q: To date How many claims have been successfully processed through NCTracks?
A: As of the last checkwrite, 9.3 million claims have been successfully processed since July 1st.
Q: How many claims have been approved? Denied? Or are pending?
A: This number changes on constant basis. The primary reason for a claim being denied are missing or incorrect taxonomy codes. We’re working on a 24/7 basis to address issues in real time and provide support to help providers with the transition.
Q: How much has been paid out through NCTracks?
A: As of the last checkwrite, the system has been on or ahead of schedule with checkwrite payments, paying out more than $350 million to health care professionals.
Q: How many claims did the state process under its previous system last year between June 20-July19, 2012?
A: The system processes 88 million claims per year from North Carolina health care professionals. It’s difficult to compare week to week because it always varies.
Q: How much was paid out through previous system between June 20-July19, 2012?
A: Each year, the system pays out more than $12 billion to health care providers who bill through Medicaid. Again, it’s difficult to compare week to week because it always varies.
Q: What is your response to providers who say they are in hold for more than an hour and when they get through to a person at the call center- they are not helpful or knowledgable about their specific questions?
A: Providing timely customer service to get answers to provider questions is the top priority during this transition. The average hold time varies from day to day primarily because the issues being reported differ greatly in level of complexity. We are adding additional call center capacity and have extended hours to Saturday, from 9:00 to 4:00 pm, to assist providers.
We also have the following additional resources:
• Scheduled training workshops continue around the state for healthcare providers. Providers can see the schedule and register here: https://www.nctracks.nc.gov/content/public/providers/provider-training.html
• At the same web site, providers can get comprehensive online training and view recorded webinars.
• Frequently asked questions and announcements are posted on the NCTracks portal as well.
• Members of the NCTracks response team are specifically designated to educate billing clearinghouses/trading partners, healthcare associations and societies about taxonomy post go-live.
• The Department of Health and Human Services and its vendor, CSC, are calling providers directly who are having the most difficultly using taxonomy.
Q: What is the average wait time for people trying to get in touch with your call center?
A: Wait times continue to be elevated, for instance, an average of 47 minutes yesterday. Each day, wait times continue to improve, and we continue to add agents and system capacity to meet demand during this transition. For instance, we have announced that the call center will be open on Saturday, from 9:00 to 4:00 pm, to assist providers.
Q: A training website was unavailable around 11:30 am today- is there another option for people to access training?
A: The NCTracks team is currently looking into this. Training is still available online and in person. For instance, there was a packed training session in Charlotte this week with hundreds of providers, and we sent technicians from the Department and CSC to sit down at tables and answer questions from providers face to face. Additionally, when people call the call center, despite the long wait times, our agents will stay on the phone with them and often walk them through the claims submission process from start to finish.
Q: What is your response to providers who say that taxonomy codes were not properly linked to providers billing numbers?
A: Taxonomy is a mandated standard and widely used by other states in their Medicaid systems. The taxonomy codes for NCTracks are different than the taxonomy codes used in the 35-year old system system. We recognize this is an adjustment, and there is an online tool to help providers look up the proper taxonomy codes in NCTracks, and are proactively calling providers who are experiencing the most difficulty with taxonomy: http://ncmmis.ncdhhs.gov/taxonomy.asp
Q: Some providers say that NCTracks required new taxonomy codes - but many clearinghouses and provider computer systems weren't set up to maintain that information. What is your response to providers who say NCtracks didn't notify them about the changes in a timely fashion or nor until after claims were denied?
A: Beginning last year, we implemented a host of communications on taxonomy and general information on the NCTracks system which many clearinghouses found useful in their transitions. Additionally, members of the NCTracks response team are specifically designated to educate billing clearinghouses/trading partners, healthcare associations and societies about taxonomy post go-live. What’s important to note for providers who are still in the process, is that they can use the portal to get claims paid until they get their own systems aligned with NCTracks.
Q: Many people are facing not making payroll or providing services - is there any recourse for providers who may be waiting for a payment and facing a financial crisis?
A: We understand the importance of timely reimbursement to providers and are proactively reaching out to providers who are having the most difficulty submitting claims. We know from the calls and emails that we have received, the other primary reason a provider may not get paid is that while their claims have been approved, provider profiles are missing key bank account information. We urge providers to log in to the portal and make sure their bank account information is up to date and current, making any necessary changes to ensure we can make payments.
Q: Will NCtracks proceed as planned? Or will the system be reviewed or altered in any way?
A: Yes, the NCTracks system is being implemented as planned. I think it’s important to note that we have moved both to a new technical systems as well as a taxonomy-based system. As we expected, there will be a 30-90 day rough patch as the system stabilizes and providers adjust to using the new system. We will continue to tweak as needed, but expect providers to appreciate the benefits of the system as they make the transition. NCTracks will help us make more precise payments and decrease the likelihood of fraud and abuse in the state Medicaid program. It will also help improve customer service and efficiency by reducing paperwork for our state’s healthcare providers and making it easier for them to get reimbursed quickly and accurately through a digital submission process.