Connections

Greetings from Eastpointe’s Claims Department. We hope

you will find this newsletter helpful in answering claims

questions.

LME-MCO

Communication Bulletin #J331

Reminders

July 2019 Checkwrite Schedule

Denial Spotlight

Quick Links

In This Issue Fiscal Year 19 Deadlines for

State Funded Claims

July 4th

Independence Day

Submission of State Funded Claims

The deadline to submit State funded claims for FY 18/19 will be the last scheduled checkwrite

cut-off in September.

• Claims with dates of 07/01/18 - 06/30/19 must be received by Eastpointe on or before 5pm,

Tuesday September 24, 2019 to be considered for payment.

• Claims for these dates of service received after the deadline will be denied.

Submission of Time Limit Override Requests for State Funded Claims

The deadline to submit time limit override requests for FY 18/19 State funded claims will be 5pm,

Friday October 11, 2019.

• This included dates of services 07/01/2018—06/30/2019.

• Requests for these dates of service, unless related to retroactive Medicaid Coverage, received

after the deadline will be denied.

LME-MCO Communication Bulletin #J331

Claims Connections Newsletter Page 2

NC Medicaid Fee-For-Service Rate Correction for RB-BHT Codes.

Rates effective 7/1/2019 for RB-BHT Codes have been corrected and published by NCDHHS as follows:

https://mco.eastpointe.net/uploads/document/JCB331-RB-BHT-CodesServiceRateCorrection-07012019.pdf

The full announcement can be viewed by clicking the link below.

Page 3

Rate Increase—T2025HO

Specialized Consultative Services BCBA

A rate increase has been approved for this service. The new rate is

$38.63. Effective, date of service 6/12/19, claims received for this service

will be paid at the new rate. Claims that have already been submitted

with a lower billed amount lower than $38.63 will need to be replaced by

submitting replacement claims with the appropriate billed amount.

Claims submitted with a billed amount higher than $38.63 and paid at

the lower rate will be re-adjudicated by Eastpointe.

YP821– Three-way Claims with an

Admission and Discharge Date That

Spans Across Fiscal Years

For budgeting and prior authorization purposes, The NC Department of

Health and Human Services - Division of MH/DD/SAS has requested that

Three-way (YP821) claims with dates of service that span across fiscal

years be submitted as two separate claims, based on fiscal year dates.

Example: A member is hospitalized. The admission date is 06/27/18. The

discharge date is 07/04/18.

Two separate claims will need to be submitted for payment.

Claim one: Bill Type: 0112 for DOS 06/27/18-06/30/18 for 4 units

Claim two: Bill Type: 0114 for DOS 07/01/18-07/04/18 for 3 units

Claims not submitted in this manner risk being denied.

Page 4 Claims Connections Newsletter

Checkwrite Schedule for JULY 2019 Cut-off Dates

Checkwrite Cutoff Date

Checkwrite Date

EFT Effective Date/RA Available Date

7/2/2019 7/9/2019 7/10/2019

7/9/2019 7/16/2019 7/17/2019

7/16/2019 7/23/2019 7/24/2019

7/23/2019 7/30/2019 7/31/2019

Updating Member’s Insurance Information

Providers can update a member’s insurance policy information in NCTracks by sub-

mitting the NC Provider 2057 Insurance Referral Form. NCTracks states, this is the

most efficient and timely way to update a member’s insurance information on

NCTracks. Within 3 days of the form’s submission, HMS will review it, verify policy

information and update the member’s policy information on NCTracks. Below is a

link to the website which contains a link to the form.

NC Provider 2057 Insurance Referral Form Website

Page 5

JUNE 2019 DENIALS

Many of your claim related questions can be answered via our website at www.eastpointe.net under Provider then Contracting and Payment.

For additional assistance you may contact your Claims Specialist as assigned by Alphabet below.

Individual Practitioners who use their name as a business name should contact the specialist assigned the first letter of your last name.

A-G Teresa Dean 910-272-1247

H-N Angela Priest 910-272-1551

O-T Brandi Oxendine 910-272-1241

U-Z Paulette Faison 910-272-1220

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CLAIMS & BILLING MANUAL FY18/19

STANDARDIZED MCO CHECKWRITE

SCHEDULE

EASTPOINTE RATE SHEET FY 18-19