After NCAMES has held over two dozen meetings with DMA over the last 20 months, NCTracks has made the following announcement.
|“Beginning March 1, 2015, NCTracks will pay the entire Medicare cost sharing amount (deductible, coinsurance and copayment) on claim detail lines for dates of service (DOS) during the time when a recipient is identified as QMB (qualified Medicare beneficiary). The “lesser of logic” to which most Medicare crossover claims are subject will no longer be applied to claims for QMB recipients. This includes Medicare crossover claims for services not covered by Medicaid and claim detail lines that were denied by Medicare during the time when a recipient is identified as QMB, as well as Medicare Part C claims.
This change affects claims subject to QMB cost sharing regardless of how they are submitted, both when they automatically crossover from Medicare and when the secondary claim is submitted directly to NCTracks by the provider.”
NCAMES wants to see if our Members are now seeing these claims paid WITHOUT manual intervention – PLEASE NOTIFY NCAMES if your claims ARE NOT PAYING CORRECTLY AFTER MARCH 1.
NCAMES is still working with DMA to attempt to have all Medicare crossover claims subject to QMB cost sharing that were processed by NCTracks prior to March 1, 2015, to be reprocessed to reimburse providers for the entire Medicare cost sharing amount. More information will be provided after our follow-up meeting on March 31, 2015.
NCAMES will continue to work with the Department and top leadership to get the best resolution possible.