NCTracks, the ailing Medicaid claims system, has been under scrutiny by several legislative oversight committees and the state auditor’s office in the last few weeks. The North Carolina Medical Society (NCMS) has been following the situation closely and helping our members where we can – as we  have since the new system went live on July 1. NCMS executive vice president and CEO Bob Seligson was quoted in articles and newscasts across the state commenting on the auditors’ findings. You’ll find a list of that media coverage at the bottom of this article.

On December 2 the Joint Legislative Oversight Committee on IT convened for its monthly meeting, and NCTracks was on the agenda.  Several practice administrators addressed the Committee. Thanks to the North Carolina Medical Group Managers (NCMGM) for assembling a panel comprised of Kim Sparks, Nash OB/GYN Associates; Sherry Williams, Piedmont Triad Anesthesia; and Christina Young, Cabarrus Eye Center who did a fantastic job describing the system’s shortfalls while offering solutions and staying optimistic.

Joe Cooper of the North Carolina Department of Health and Human Services (DHHS) and Joel Mercer of CSC responded briefly to some pointed questions from Committee members following testimony from the provider panel.  Main points discussed:

NCTracks Working Group  Committee members latched on to an idea offered by the panelists to create a multi-stakeholder working group that would meet frequently and regularly with DHHS and CSC to work through the problems.  DHHS and CSC did not indicate whether they would do this or not.

Modification of CSC’s “Five and Out” Policy.  Previously, if a CSC representative called a provider five times and received no response, the underlying issue originally reported by the provider would be closed out.  Legislators had learned that (1) CSC calls were frequently made in the evening and messages left without call back numbers; (2) representatives are often unavailable to talk when a provider calls back; and (3) problems were being closed out prematurely.  Cooper reported that the policy is still in place but has been adjusted so no calls are made after 4 p.m., an email notice will be sent after the fourth call, and contact information is now always left by the CSC rep.   

Claim Turnaround Times.  According to CSC, most claims are being paid in far less than the 30-day requirement.  However, there are still many that have exceeded that limit due to various system-related reasons.

Just a week later on December 9, the North Carolina State Auditor released a performance audit report on NCTracks implementation after its go-live date on July 1.  The findings are striking and confirm what the NCMS has been hearing from its members about the problems they have and are continuing to encounter. Read the full report here.

In summary, the findings of the audit are:

• Since going live, the NCTracks system has encountered more than 3,200 defects.
• The Department has an inadequate framework for the timely resolution of NCTracks defects.
• The state lacks a comprehensive action plan to address all NCTracks issues.
• Federal and state government mandated changes have not been implemented within their target or mandatory implementation dates.
• The state government ‘revolving door’ creates a perception of bias or conflict of interest.

 And the auditor’s recommendations are:

•  The Department should establish official guidelines, metrics, and a methodology for tracking the timely resolution of defects. The Department should monitor CSC performance against these metrics.
• The Department should develop a comprehensive master action plan to fix NCTracks issues.
• The Department should provide the General Assembly a follow-up report that includes implementation dates and cost data for all changes that have yet to be implemented.
• The General Assembly should consider a narrow change to state law to limit the ability of senior level state government employees to go directly to work for a vendor they directly managed while employed by the State.

Finally, the Joint Legislative Oversight Committee for Health and Human Services convened on December 10, the day after the release of the auditor’s report. DHHS Chief Information Officer Joe Cooper defended the performance of NCTracks, even going so far as to say it has been a “successful launch.” 

Here is a partial list of some of the media coverage of the auditor’s report and NCMS response.

Raleigh News & Observer coverage of Joint Legislative Oversight Committee meeting reviewing auditor’s report: http://www.newsobserver.com/2013/12/10/3449750/dhhs-staff-defends-troubled-nc.html

Charlotte Business Journal coverage of auditor’s report: http://www.bizjournals.com/charlotte/blog/morning-edition/2013/12/audit-cites-3-200-defects-in-nc-medicaid-payment.html?ana=e_du_pub&s=article_du&ed=2013-12-10

Asheville Citizen Times report on auditor’s findings:  http://www.citizen-times.com/viewart/20131210/NEWS/312100034/Audit-finds-issues-NC-Medicaid-system

Winston-Salem Journal report:  http://hosted.ap.org/dynamic/stories/N/NC_MEDICAID_BILLING_SYSTEM_NCOL-?SITE=NCWIN&SECTION=HOME&TEMPLATE=DEFAULT