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A new tab titled Managed Care Payment Outcome Summary is being added to the Managed Care Claims Monitoring Dashboard. Managed Care Payment Outcome Summary data includes only the latest payment outcome for services captured across multiple claim submissions. The Payment Outcome Summary data identifies claims with the same values for key fields based on the Claim Type and determines the payment outcome accounting for all claim iterations.
The Key Fields by Claim Type:
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Pharmacy: Beneficiary ID, Billing Provider NPI, From Date of Service, Prescription Number, Units Paid
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Institutional Ambulance: Beneficiary ID, Billing Provider NPI, Attending Provider NPI, From Date of Service, To Date of Service, Procedure Code, Type of Bill, Revenue Code, Diagnosis Codes, Pick Up Time
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Institutional Inpatient: Beneficiary ID, Billing Provider NPI, Header From Date of Service, Header To Date of Service, Type of Bill, DRG Code
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Institutional Outpatient: Beneficiary ID, Billing Provider NPI, Attending Provider NPI, From Date of Service, To Date of Service, Procedure Code, Type of Bill, NDC Code, Revenue Code, Diagnosis Codes
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Professional: Beneficiary ID, Billing Provider NPI, Rendering Provider NPI, Diagnosis Codes, From Date of Service, To Date of Service, Procedure Code, Procedure Code Modifiers, Place of Service, NDC Code
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Professional Ambulance/NEMT: Beneficiary ID, Billing Provider NPI, Rendering Provider NPI, From Date of Service, To Date of Service, Procedure Code, Procedure Code Modifiers, Place of Service, NDC Code, Diagnosis Codes, Pick Up Time
Please see the NC Medicaid Dashboards webpage for more information.
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