Reminder: Credit Balance Audit and Quarterly Reporting Requirements

Providers participating in the North Carolina Medicaid program are reminded of their responsibility to complete regular credit balance audits and submit required Credit Balance Reports. These reports help ensure that any overpayments or improper payments owed back to Medicaid are identified and resolved promptly.

All providers must submit a quarterly Credit Balance Report to the NC Medicaid Third-Party Recovery Section when outstanding balances are due to Medicaid and have not been reported previously. Hospital and skilled nursing facility providers, however, are required to submit a report every calendar quarter—even when no credit balances exist.

Reports must be submitted no later than 30 days after the end of each calendar quarter:

• March 31
• June 30
• September 30
• December 31

What Is a Credit Balance?

The Medicaid Credit Balance Report is used to monitor and recover funds owed to the Medicaid program. A credit balance occurs when a provider receives an improper or excess payment. Common examples include:

• Duplicate payments from Medicaid and another payer, such as Medicare, commercial insurance, or liability insurance
• Patient liability amounts not reported during the billing process
• Billing system or computer processing errors

For reporting purposes, a credit balance is any amount determined to be refundable to Medicaid, regardless of how it is categorized within a provider’s internal accounting records.

Providers remain responsible for repaying funds owed to Medicaid even if a credit balance is transferred to another account, placed in a holding account, or written off internally. These actions do not relieve providers of their obligation to identify and return overpayments.

Electronic Submission Through the HMS eCenter Portal

The Credit Balance Reporting process is fully electronic through the Health Management Systems (HMS) eCenter Self-Disclosure Portal. This system improves reporting efficiency, reduces paper and postage costs, and provides providers with a date- and time-stamped confirmation of submission.

To submit Credit Balance Reports electronically, providers must register for access to the Self-Disclosure application in eCenter.

How to Access the HMS eCenter Portal

1. Navigate to the HMS eCenter website: HMS eCenter Portal.

2. If you have never used eCenter, select Start here for new access.

   • Complete and submit the registration form.
   • Watch for a follow-up communication from the HMS Help Desk.
   • Inform the Help Desk that you need access to Provider Portal Provider Overpayment Reporting–NC.

3. If you are already an eCenter user, contact the HMS Help Desk at 855-554-6748 and request access to Provider Portal Provider Overpayment Reporting–NC.

Submitting Refunds

Submitting a Credit Balance Report does not automatically return funds to Medicaid. Providers must select a refund method and complete the appropriate reimbursement process. Available options include:

• Submitting a replacement claim
• Mailing a refund check with the NCTracks Provider Refund Form
• Requesting NC Medicaid to adjust the claim on the provider’s behalf

NC Medicaid identifies provider-submitted claim adjustments through NCTracks as the preferred method for satisfying credit balance refund requirements.

If requesting NC Medicaid to adjust a claim, providers should verify that all cost-share and overpayment amounts are reported accurately.

Important Compliance Reminder

Failure to submit required Credit Balance Reports may result in Medicaid payments being withheld until the report is received.

Providers are encouraged to review their accounts regularly and complete quarterly reporting requirements on time to maintain compliance and avoid payment disruptions.

Additional Resources

Instructions (Form 2045) and formatting requirements (Form 2044-IA) for the quarterly Credit Balance Report are available on the NC Medicaid website:

NC Medicaid Third-Party Insurance Forms and Credit Balance Reporting Resources

For additional guidance, review the available forms and instructions before preparing your next quarterly submission.