NCTracks Transition Includes Hidden Physician Rate Cut

Members of the Carteret County Medical Society suffering, as many other health care providers throughout the state, from the problems with the new NCTracks Medicaid reimbursement system, recently identified a hidden rate cut in NCTracks.

When NCTracks launched on July 1, Medicaid simultaneously implemented a new methodology for calculating payment rates on crossover claims where Medicare provides primary coverage and payment. 

Medicaid calls the new methodology “Lesser-of Logic,” and so far has issued only skimpy guidance about the change.  Link to that publication here and note the explanation in Example 2.

In all examples seen so far, the Lesser-of Logic generates payment rates on Medicaid secondary claims that are lower – and often dramatically lower – than the rates paid on Medicaid secondary claims prior to July 1.  

Over the previous week, NCMS has communicated its strong objections to Medicaid leaders about this surprise, unauthorized rate cut.  We question its legality, and continue to urge Medicaid to restore the pre-July methodology immediately.  If our direct efforts with Medicaid do not bring a satisfactory resolution, we plan to take our advocacy efforts to other venues.

NCMS encourages you to share this latest complaint about NCTracks with your elected officials. The Carteret County Medical Society took this message to heart and recently hosted state Rep. Pat McElraft and Sen. Norman Sanderson to discuss NCTracks and the negative impact the transition has had on patient care and the financial wellbeing of medical practices.


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  • To KS, I understand why you put that link regarding the crossover payment method. But what a lot of people are not understanding is that according to the ACA, Medicaid is to allow the same as Medicare and pay accordingly. If Medicaid pays accordingly to the allowable amount equal to Medicare, then whatever isn’t paid by Medicare should be paid at 100% by Medicaid. That is, the coinsurance and deductible amounts. The link to which you are referring from March 2002 does not apply here. NC Tracks still has not explained why they are not upholding the rules of the ACA and paying according to it.

  • We have been experiencing issues with not getting paid for varied procedure codes as well as being paid $0.00 for most Medicare Advantage plans, which are crossed over to Medicaid due to the Hidden Physician Rate Cut after July 1. The call center is of little or no help, but grateful for those at the Department of Health & Human Services who have provided the assistance that they are able to. Time for a solution!

  • This is a link to the dhhs website where it states the crossover payment method.

  • Rita Richardson

    I have worked in medicine for 30 years and this process of switching to NC Tracks has been the most unorganized and unfair change that I have encountered. The Medicaid patients as well as the physicians that treat them deserve better than this! More providers will be forced out of business and patients will be left without physicians! These underhanded cuts will be the icing on the cake!

  • Why not use “Greater of Logic?”

  • The worst thing about this recent pay cut by Medicaid is the covert way in which they went about implementing it — as if we wouldn’t notice. What a disgraceful way to conduct business! If we can’t trust the governemnt agencies to be transparent and symbiotic, why bother participating in their programs?? We too will evaluate whether or not we will continue to be a participating provider with the Medicaid program.

  • After seeing this article, I discussed with my insurance coordinator. She states she noticed the change and reduction of secondary reimbursement. I strongly agree with others that physicians who treat Medicaid patients should not be penalized with a rate cut! Hoping this is corrected soon. Just wrong!

  • Extremely disappointed in this underhanded way of cutting provider payments. It took several weeks to get claims to process correctly so payments could be made. The fact that the payments were a small percentage of what was expected was just a slap in the face. The state only hurts itself. The money “saved” by cutting reimbursement rates will be used for unemployment claims when medical workers are laid off.

  • Elisa Roberts, MD

    This hidden rate cut just recently came to my attention. I am appalled at the backhanded way this was done and am seriously considering withdrawing participation from NC Medicaid. My Medicare crossover Medicaid claims have been paying at near ZERO since July 1st due to this change.

  • Our office is extremely frustrated by this tactic of NC Tracks. We would be happy to pursue options in getting this situation corrected. Physicians who treat Medicaid patients should not be penalized with a rate cut on a fee schedule that is already too low.

  • Adel Mohamed

    Our urology group is suffering drastically from the new NC Medicaid carriers. The physicians were not paid for two months secondary to their transmission errors since NCTracks started July 1. It appears that they intentially blocked the transmission to delay payments and making all excuses . They should have all their IT in order before they are responsible for many millions patients North Carolinian lives.
    Our group strongly believe that our NC Medical Society should give NCTracks one month warning to correct their illegal actions , otherwise to go ahead with legal action immediately.
    Adel Mohamed, MD
    Mohamed &Lippit urology ,PA
    Smithfield , NC

  • Anthony Kokx

    This backdoor and illegal rate cut cannot stand. This shows a disrespect for NC Medicaid patients and the doctors who treat them. Anything but complete revision will result in legal action.