HOSAR Payment Denials - Medicaid Managed Care

Providers with Denials for Healthy Opportunities Screening, Assessment and Referrals Claims due to Edit 02088 May Now Resubmit Claims 

An issue was identified with provider claims denying due to edit 02088 which enforces a rule that coverage of the procedure code G9919 for Healthy Opportunities Screening, Assessment and Referrals (HOSAR) positive screenings, be limited to providers affiliated with Carolina Access II (CAII) based on the rendering provider NPI. Upon review by the State, the edit disposition has now been updated to allow the claims to be properly adjudicated by updating the affiliation basis to the billing provider NPI. Affected providers should resubmit claims that were denied for this issue.  

Also, before you resubmit, please note: 

1. Code G9919 cannot be billed as telehealth.   
2. Code G9919 does not require a modifier 
3. T1015 should not be combined on a claim with code G9919 
4. Please verify the following information for the rendering provider 
   • Is affiliated with the office
   • Is a NC Medicaid provider and is active in NCTracks
   • Has an active taxonomy
   • Taxonomy should not be single or multispecialty 
5. Verify the CCNC Affiliation location and place of service match 
6. Procedure codes should always have a billed amount (usual and customary)  

Place of Service Indicator Codes Updated 

Some claims have also denied for Place of Service (POS) mismatch. This table of codes are the allowable POS for billing G9919.  

For questions on the HOSAR payment contact NCTracks Call Center; 800-688-6696 or NCTracksprovider@nctracks.com