North Carolina Medicaid: NC Tracks
Please follow the Enrollment Instructions below to become an electronic submitter for North Carolina Medicaid.
Required Documents for those applying for new Submitter ID's
The following documents are required enrollment documents that must be completed, signed and returned to the DHHS office prior to initiation of electronic claims submission or inquiry.
1. Trading Partner Agreement
The Trading Partner Agreement will become available once you enroll as a billing agent within Ramp Management. For information on how to obtain an account please call the NCMMIS EDI Help Desk at 1-800-688-6696 or email NCMMIS_EDI_Support@csra.com
We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
Trading Partner Agreement
Enter your name as the trading partner and leave the log on id blank
Enter the Provider Number(s)
Software Name: Please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.
Section I: Please enter today's date
Section IA 1-4: Please enter your facility address and information for the main contact person for your office
Section VIII: Please sign and date both lines
Appendix A: Transaction Sets
Section 1: Please choose the following:
For UB04 Claims-Institutional Claim: ASC X12N 837 004010X096A1 - Health Care Claim: Institutional
In the future this should change from 837 004010X096A1 to 005010X223A1 for 5010 transactions
For CMS 1500- Professional Claim: ASC X12N 837 004010X098A1 - Health Care Claim: Professional
In the future this should change from 837 004010X098A1 to 005010X222A1 for 5010 transactions
Health Care Payment and Remittance Advice:………(To receive your EOBs electronically)
Transmission Receipt Verification ASC X12 997 004010
In the future this should change from X12 997 to X12 999 for 5010 transactions
Sign and Date both lines and the bottom
Appendix B: EDS Communications and Contact Information
Section 1: Please Choose the following
Secure FTP Communication
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records
Mail the Trading Partner Packet to:
HP Enterprise Services
2610 Wycliff Road, Suite 401
Raleigh, NC 27607
Attention: ECS Department - TPA
It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.
Waiting for a Response
Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two to three weeks from the date of receipt. (Remember that mailing time can take as much as five days.)
After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after three weeks, contact the EDI Help Desk NCMMIS EDI Help Desk at 1-800-688-6696 or email NCMMIS_EDI_Support@csra.com
There will be no need to send Test claims. Once you are set up to send claims they will be going straight to production for payment.