DMA’s Own Error Regarding NCTracks Causing Dentists Undue Hardship?

As a Medicaid attorney and a bloggist (is that a word?), I tend to get numerous phone calls during the day from people with “information” or “evidence” that will, if I use it correctly, “take down Medicaid.” Numerous callers claim to have “smoking guns.” First of all, I do not wish to take down Medicaid. I only wish that Medicaid recipients receive good, quality healthcare, Medicaid providers receive reasonable reimbursements , and the State of North Carolina manages Medicaid in a cost-efficient, effective manner. One can dream, right?

With all the “smoking gun” phone calls, I rarely publish a blog without considerable research. Today, I am bucking my own rule. This blog is unverified. This blog is based-off of a telephone call.  The only reason I am publishing an unverified blog is because (a) Medicaid is so crazy right now…so many changes…so many players…so many bad things happening to Medicaid providers that, I believe, the more information the better; (b) I do not believe I could ever verify this blog completely; and (c) if this blog is even partially correct, maybe, I will educate/inform some dentists who accept Medicaid.

I received a phone call today from a dental provider in the western part of North Carolina.  She gave me some pretty disturbing information about NCTracks.  According to her, (we will call her Jane), NOT ONE dental Medicaid provider has received Medicaid reimbursements from NCTracks, which went live July 1, 2013. (Now, obviously, Jane has not contacted every dentist in NC who accepts Medicaid, so this information is not verified). However, according to Jane, her information source, besides her colleagues and friends with whom she has discussed this issue, is the Division of Medical Assistance (DMA). So this is not verified, but…

Still…what if it is only 1/2 true? Then Department of Health and Human Services (DHHS) has been less than upfront regarding the success of NCTracks.

If an NCTracks problem were so widespread, wouldn’t DHHS have issued some sort of statement? So I looked.  I found:

For Immediate Release
Monday, July 8, 2013

Raleigh, N.C. – Today, the North Carolina Department of Health and Human Services (DHHS) announced that NCTracks will successfully pay its first round of Medicaid claims this week, surpassing expectations of many health care providers.

“NCTracks is working so well after its first week in operation, we will pay many claims a full week ahead of schedule,” said Joe Cooper, Chief Information Officer for DHHS. “We are continuing to address specific technical issues as they come up, but this should be welcome news to North Carolina’s hospitals, long-term care facilities, physicians, dentists and pharmacies.”

Working so well that NCTracks will be paying providers a week early???? Really?  This same quote was published in the Triangle Business Journal three days ago in an article explaining that providers have not “sounded praise bells to quite the same tone, [but] there hasn’t been a widespread negative outcry either.”

According to Jane, who runs 6 dental practices, Jane has not received 1 penny from Medicaid since June 20, 2013 (the cut-off for billing before NCTracks went live). Almost 1 month. In order to meet payroll, Jane was forced to get a loan from a bank.  So far, Jane’s dental practice is owed approximately $300,000 in unpaid Medicaid reimbursements, no small amount, especially when Medicaid reimbursements barely cover administrative costs as it is.

To make matters worse, Jane was informed by the Division of Medical Assistance (DMA) that the Wednesday, June 17, 2013, checkwrite (EFT effective date) will not occur.  She also heard that the Tuesday, July, 23 2013, checkwrite date will not occur unless quick and drastic measures are taken.

Jane said that, at first, Jane was worried that she was not doing something correctly and that the lack of reimbursements were somehow her fault.  She contacted DMA and asked many questions. 

She heard (unverified) that DMA knows of this issue (the issue that zero dental providers are receiving reimbursements from NCTracks) and that DMA has admitted via email that DMA, itself, made a mistake that led to the nonpayment of Medicaid reimbursements to dentists.  As in, the fact that dentists have received zero reimbursements since NCTracks’ inception is due to DMA’s own fault. (Something about incorrectly linking providers’ Medicaid numbers…)

Without Medicaid reimbursements, many smaller dental practices will be forced to close because they simply cannot function without these Medicaid reimbursements; they won’t be able to make payroll.

While I readily admit that this blog is unverified, if it is correct that all (or even most) dentists are not receiving Medicaid reimbursements, then I say, “Shame!”

If this is a widespread, state-wide issue for all dental providers who accept Medicaid, I say, “Shame on you, DHHS, for not publicizing that Medicaid reimbursements are not being paid to dentists across the board.”  Many dental providers are probably, as Jane did at first, wondering what they are doing wrong.  They have probably wasted hours and hours reviewing the billing claims and trying to assess what the problem is (probably blaming the billing person at their office).

We all understand DHHS’ utter abhorrence if (a) this were true; and (b) the media found out, but, AT THE VERY LEAST, publicize the issue to the dental providers adversely affected.

NCTracks has been a heated issue for DHHS since the beginning.

Before NCTracks ever went live, the NC Office of State Auditor issued a report that NCTracks had failed to fully test a new $484 million computer system scheduled to begin processing Medicaid claims on July 1. See my blog on NCTracks.

Since July 1, 2013, when NCTracks went live, I have heard numerous complaints. But, from I have seen in the media, DHHS has touted NCTracks’ success, saying, despite some bugs (which are to be expected), NCTracks has done great.

What about the dentists?

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on July 15, 2013, in Beth Wood, Dental Medicaid Providers, Dentistry Services, Division of Medical Assistance, Health Care Providers and Services, Medicaid, Medicaid Audits, Medicaid Billing, Medicaid Reimbursement, Medicaid Reimbursements, NC DHHS, NCTracks, North Carolina, Office of State Auditor and tagged , , , , , , , , , , , , , , , . Bookmark the permalink. 18 Comments.

  1. This was correct. We have not been paid since June 28. According to the DMA’s website, we should be paid by July 17. That would be 19 days between checks….. a long time .

    From the DMA website:

    “Note: The first NCTracks checkwrite will be July 9, 2013, but will apply only to pharmacy point-of-sale (POS) providers. Other providers will receive their first claims payments the following week.”

  2. I have received reimbursement for the July 9th Check write. It showed up as an electronic payment in my account on July 11th.

  3. sidney brooks

    I am a dentist in Sanford NC and I have not been paid by Medicaid since June 27. They stopped accepting our claims June 20th.

  4. We’re a mental health agency. We should have been paid today for the first time since the 20th but of course we weren’t. No RA posted either, even though we received an RA for last week’s claims. Sad to say but I wasn’t expecting to get paid because I have no faith in DHHS’ ability to implement any program. They are the epitome of governmental incompetence.

  5. Well, we were not paid today by DMA, and no one at DMA has any answers. We will have to start making adjustments with the schedule to meet payroll. This is really horrible.

    This was just on the news tonight about local dentists receiving no Medicaid payments with the new computer system.

  6. This is absolutely accurate and correct. This is happening to our 2 practices, one in Charlotte and our new office in Huntersville. This is the deception that Doctor and I as the Office Manager are experiencing. Very sadly to say we have had the run around for the past 3 weeks as of when we will get payments in so we can continue operations and make payroll. Today the owner was faced with withdrawing monies from his 401K to make the payroll for the staff since our practices are 65% Medicaid based.

    We love our job and servicing the community; however we won’t be able to survive if we don’t receive payment for our services.

    At this point we have contacted the senators and we areliving our way up to see if we are heard. I am appalled at how we are still awaiting on payments from claims of 06-20-2013, when NCTRACKS was supposed to take over on July 1st.

    I would like to get Action 9 involved and see what else can be done to expedite these payments to all the providers.

    If so, why did they even switch the system. What a disappointment.

  7. Sidney Brooks did you get paid today? Just curious since your also a dental provider. We did not get paid today, and all of my fellow dentists have not been paid either for weeks now.

  8. Your blog is invaluable Knicole. PLEASE keep posting the truth!!

  9. More news coverage tonight on the lack of payment from DHHS to other NC Medicaid providers besides dentists with the new NC Tracks system.. ( i.e. Pediatricians, medical supply companies, etc.) Just ridiculous.

  10. I have not been paid yet either and it is shameful. If this is some nefarious plot to thin out the number of providers I think it is working. We have been on the phone for HOURS and still no resolution. They blame our third party processor and our third party processor blames them. We are stuck in the middle


    I believe her. As a biller for a DME company, not only can we not get paid, but the system is really not set up to accept claims properly….at least I cannot get it to work. Trying to reac h NCTracks is a minimum of 60 minutes wait and then most of the responders will tell you they are not trained to answer the question. If you call technical support, often the voice mail says they are not available to take your call at this time..try your call later. Really? this is efficient????

  12. More media attention in both the Charlotte and Raleigh market on the nightmare in dealing with NC Tracks and providders not getting paid…..

  13. Small business owner over here YELLING AT THE TOP OF MY LUNGS! Its not just Dental. HOME CARE has not been paid either. Same issues. Thank you for bringing it to light because yes NC TRACKS would have you believe that the error was in your billing and taxonomy codes etc etc

  14. NC Tracks Sucks

    As of today (July 25, 2013), my company has not been paid by NC Tracks. The test claims that we submitted prior to the NC Tracks live date was “successful” according to the system. But once they went live, every claim that we submitted were “DENIED” due to various reasons. The first one was “taxonomy code” issue, the second was “no authorization” even though we have approved authorizations for each client. After all these issues were corrected, we were told that the DMA has something to do with the claim denials. We can’t stop providing services to our clients because they are considered to be “high risk” population. The total amount of unpaid claims is about $50,000. We already had two payrolls without being reimbursed. Each payroll is about $60,000. So our reserve is already exhausted. We now have to seek a loan from the bank to pay our staff.

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