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Assessing Eligibility for the North Carolina Medicaid Personal Care Services

Contact Information

About Billing Issues

NCTracks is the multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services. Within this system, providers should submit Prior Approval (PA) requests via the Provider Portal.

For detailed information, providers should access NCTracks Provider User Guides, and Training.

Helpful Tips When Troubleshooting Prior Approval (PA) Billing Issues

It will save you valuable time if you verify the following information when encountering issues trying to bill for PCS:

Via QiRePort Provider Portal

  • Did you complete a service plan for the most current assessment for the beneficiary?
  • Does the modifier on the PA match the modifier assigned to your agency in NCTracks?

Via NCTracks Provider Portal or by calling 1-800-688-6696

  • Does your beneficiary have active Medicaid?
  • Does your beneficiary have active PAs?
  • Have you already billed for all approved hours this month?
  • Are you billing within the approved effective dates?

If you have verified this information within QiRePort and NCTracks, but are still encountering issues, you may submit a Request for Prior Approval (PA) Research Form to Liberty Healthcare for further assistance.

The form can be found by clicking this link: Request for Prior Approval (PA) Research Form

Please allow 5 business days for Liberty Healthcare to research your request.

More Helpful Tips Below

Billing Codes

Q. What billing codes should be used for PCS Services?

A. All billing for dates of service January 1, 2013 and later must be done with the Procedure Code 99509 and one of the following modifiers:

HA In-Home Care Agencies, Beneficiary Under 21 Years
HB In-Home Care Agencies, Beneficiary 21 Years and Older
HC Adult Care Homes
TT Combination Homes
SC Special Care Units
HQ Family Care Homes
HH Supervised Living Facilities for adults with MI/SA
HI Supervised Living Facilities for adults with I/DD

Q. What error codes need to be handled by NC Tracks?

A. For claims and recoupment please contact NC Tracks at 800-688-6696. Listed below are the most common error codes not handled by Liberty Healthcare of NC.

11 beneficiary not eligible on service date
27 diagnosis codes
292 MQB status
270 billing provider is not the beneficiary's Carolina Access PCP
286 referring NPI does not match the beneficiary's eligibility file
21 duplicate request

Maintenance of Service Questions

Q. How should I bill Maintenance of Service (MOS) for a client who has entered an appeal during the PCS transition?

A. All services provided on or after January 1, 2013 must be billed using the new PCS codes. This includes services to beneficiaries who appealed a reduction or denial in services under the PCS Program and are currently authorized for MOS under the PCS Program.

Middle of the Month Issues

Q. My client's new service level becomes effective in the middle of the month. How should I write and implement the new plan of care to avoid billing problems and denied claims?

A. The PCS Provider shall provide a qualified and experienced RN, or other professional as specified in licensure rules to supervise personal care services and write or adjust the new weekly POC so that it can be implemented as soon as the new service level is effective. The new service level goes into effect either 1 - 10 days from the date of the notice, and this will be specified in the Notice of Decision letter. When a change in authorized service level goes into effect, the old authorization will end and the new authorization will begin.

Billing & The Appeals Process

Q. Liberty Healthcare of NC sent a letter indicating reduction in or denial of services that is effective 10 days from the date on the authorization letter. The beneficiary has submitted an appeal of this decision. How should the agency handle billing for services that were delivered during the appeal process?

A. Beneficiaries who submit an appeal (a request for hearing) within 30 days of the date on the authorization letter are entitled to continue to receive services at the previous level (that was provided before the decision letter was sent, and not to exceed 80 hours per month) while the appeal is pending. In order to allow NC Tracks time to update service records, providers should wait 10 days from the date the client enters an appeal before submitting billing for services provided on and after the effective date indicated in the beneficiary's notice of service denial or reduction. Once service records are updated, providers should receive payment at the previous level of service for the duration of the appeal process.

Q. I have a question about a beneficiary's appeal. Should I contact the Liberty Healthcare?

A. If the beneficiary has a current appeal in QiReport, Liberty can answer questions regarding appeals.

If the beneficiary does not have an appeal in QiReport and the agency has not received a MOS letter, please contact the Office of Administrative Hearings (OAH) at 984-236-1850 to verify if the beneficiary filed an appeal within the 30 days of the date of the letter.