Latest Posts

Medicaid Alert: Reprocessing Claims Due to Underpayment

September 23, 2021

On behalf of NC Medicaid, we are forwarding the following message, which may impact some NCMS members. NC Tracks is reprocessing some professional claims due to underpayment and will contact impacted clinicians by email of the specific issue and their rights to file for a reconsideration and/or appeal in advance of this specific claims reprocessing activity. NCTracks plans to send the targeted emails Thursday, Sept. 23, 2021, so please be on the lookout for their email. Below are more details from NCTracks.

Reprocessing of Professional Claims Due to Underpayment

This reprocessing notice applies to professional claims that were processed and paid in NCTracks from June 4, 2014 through May 29, 2018. NCTracks records show you have affected claims.

Issue: While making system updates, modifier GZ was erroneously end dated causing claims to deny in error.

Action: Claims that were incorrectly denied will be reprocessed. The affected claims will systematically be reprocessed. No provider action is required.

Timing: Applicable claims will be reprocessed in the Sept. 28, 2021 checkwrite.

Remittance Advice: Reprocessed claims will be displayed in a separate section of the paper Remittance Advice with the unique Explanation of Benefit Codes (EOB) code.

  • EOB 10108 CLAIM REPROCESSED DUE TO INCORRECT DENIAL FOR CLAIMS SUBMITTED WITH MODIFIER GZ.

The 835 electronic transactions will include the reprocessed claims along with the other claims submitted for the checkwrite. (There is no separate 835)

Important Reprocessing Information: Reprocessing does not guarantee payment for the claims. Claims that were erroneously paid will be recouped. Also, while some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were previously adjudicated may apply to the reprocessed claims. Therefore, the reprocessed claims or claim lines could deny or pay differently.

If there are not sufficient funds from claims paid in the checkwrite of reprocessing to satisfy the recoupment of an overpayment, an Accounts Receivable (AR) will be created. Recoupment of the AR will begin with the subsequent NCTracks checkwrite and the recoupment process will continue each checkwrite until the full amount due is recouped.

If funds are insufficient to collect the full amount due from the NPI for which the AR was generated, NCTracks will automatically seek to recoup the AR from other NPIs with the same Internal Revenue Service Taxpayer Identification Number. For more information about the AR process, see the announcement of February 29, 2016.

Questions: Contact the NCTracks Call Center at 800-688-6696 during the hours of 8 a.m. to 5 p.m., Monday through Friday, except state holidays.


You’re Connected to NC HealthConnex – Do You Know How to Use It?

September 20, 2021

You’re connected to NC HealthConnex, but has your organization taken the time to understand how to best use the HIE to improve the quality of care for patients?

The NC HIEA and North Carolina Area Health Education Centers (NC AHEC) have partnered to provide you with a library of virtual and in-person training to show your practice how to use the many NC HealthConnex services. Curious how these trainings can help you? These offerings provide health care professionals with an introduction to NC HealthConnex and provide insight to the services offered and how they can serve your practice.

The modules below offer a stress-free method of receiving training and staying up-to-date on all applications. Registration for the following modules is required to receive a link to the training.

For more detailed instructions on how to use the training software, visit our Training and Resources webpage here. In addition, NC AHEC Practice Support is able to help practices with Medicaid managed care education and issue resolution at no cost to the practice. This resource is accessible via practicesupport@ncahec.net with a dedicated practice support coach assigned to assist with your needs. NC AHEC Practice Support coaches also provide assistance with best practices in implementing NC HIE into your workflow and quality improvement activities.


Prepaid Health Plan Interest and Penalties for Provider Claims

September 17, 2021

In accordance with Section V. H.1.d of the NC PHP Contract, prepaid health plans (PHPs) are required to pay interest and penalties to providers if the PHP fails to accurately pay or inappropriately denies a clean claim within 30 calendar days of receipt of medical claims or within 14 calendar days of receipt for pharmacy claims.

  • This includes incorrect denials, and under- or partial-payments that are identified and paid on reprocessed claims.
  • It is the PHP’s responsibility to issue interest and penalty payments to providers when applicable.

A clean claim is a claim for services submitted to a PHP by an NC Medicaid Managed Care medical or pharmacy service provider which can be processed without obtaining additional information from the submitter in order to adjudicate the claim.

If the PHP fails to implement fee schedule changes and reprocess impacted claims with the correct rates within 45 calendar days of notification of a fee schedule change from NC Medicaid, the PHP must pay interest and penalties on the adjusted amount.

For more information, please see Medicaid bulletin Prepaid Health Plan Interest and Penalties for Provider Claims.


NC Medicaid Managed Care Provider Update

September 15, 2021

An update on NC Medicaid Managed Care was sent to providers this morning. Topics include:

  • Key dates
  • Playbook updates
  • Prior authorization
  • Frequently asked questions
  • Contracting
  • Provider ombudsman
  • Webinars
  • NC’s Provider Directory – Medicaid and NC Health Choice Provider and Health Plan Look-Up Tool
  • Health plan office hours for providers
  • PHP quick reference guides
  • NC Medicaid help center

The bulletin article is available here.


NC DHHS Notice about Ivermectin

September 15, 2021

NC DHHS and Dr. Tilson released a public health notice related to potential inappropriate prescribing of ivermectin. In addition to citing concerning trends around increases to prescriptions for ivermectin, and calls to poison control and emergency department visits connected to the drug, Dr. Tilson is asking clinicians to counsel patients against inappropriate use of the medication. Talking points are included in the letter from Dr. Tilson.

https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/state-health-director-raises-ivermectin-concerns


NC Medicaid: Temporary Provisions for COVID-19 Surge: Post-Acute PA Exceptions and Hospital at Home Program

September 2, 2021

NC Medicaid is committed to ensuring that beneficiaries receive the care they need, including lower levels of care in post-acute facilities following inpatient hospital admission, when medically appropriate.

To support providers during the COVID-19 surge, NC Medicaid is implementing the following:

Temporary Suspension of Prior Authorization for Post-Acute Placements

  • Temporary Suspension of Prior Authorizations for New Nursing Home Admissions for those Who are Being Directly Discharged from a Hospital
  • Home Health Skilled Nursing Visits Reminder: Prior Authorization is not required prior to discharge from the hospital
  • Temporary Suspension of Prior Authorization for Inpatient Rehabilitation Hospital and Long-Term Care Hospital Admissions under Managed Care
  • Reminder of Swing Bed Reimbursement Rates

Temporary Availability of the Hospital at Home

  • Effective Sept. 1, 2021, the Acute Hospital Care at Home program will be available to North Carolina hospitals that have been granted a waiver from CMS and service NC Medicaid beneficiaries. NC Medicaid is planning to implement this program to be effective Sept. 1 through Dec. 31, 2021, unless this flexibility is terminated prior to Dec. 31, 2021.

For detailed information, please see SPECIAL BULLETIN COVID-19 #178: Temporary Provisions for COVID Surge: Post-Acute PA Exceptions and Hospital at Home Program.


Expedited Hardship Advances for Managed Care Providers

August 19, 2021

The North Carolina Department of Health and Human Services (DHHS) and prepaid health plans (PHPs) are committed to supporting providers during the transition to managed care. We stand by the Day One goal to ensure providers are paid for services they provide. DHHS and PHPs are aware of potentially delayed payments and increased claim denials during the transition period.

Providers experiencing claim payment issues should initially work with the PHPs to address claim issues and avoid the need for a hardship advance. Refer to the Guidance for Providers Experiencing Payment Issues bulletin for contact information.

As DHHS, PHPs and providers address the various claim processing problems, providers who are at risk of not meeting financial obligations this month as a result of claim processing issues may request a hardship advance to offset the business cost due to pended or denied claims.

Thank you for your patience and cooperation as we work to resolve managed care transition claim issues. For more information, please see the Medicaid bulletin Expedited Hardship Advances for Managed Care Providers.


Confirming Medicaid Coverage for Beneficiaries

August 9, 2021

NC Medicaid has received reports of confusion in the field by providers and pharmacies when members do not present an ID card or when presented with a Medicaid member ID card that differs from the data shown in the NCTracks system.

To mitigate any confusion associated with newly issued Medicaid Managed Care member ID cards, providers and pharmacies should always use NCTracks Recipient Eligibility Verification/Response to confirm eligibility and not rely solely on the information shown on a Member ID Card.

Health plans are required to generate an identification card for each Member enrolled in their health plan that contains the Member’s North Carolina Medicaid or NC Health Choice Identification number. Some health plans also include their health plan member ID as well. However, member ID cards are not required to provide service, and this includes pharmacies as well. Therefore, members should not be turned away due to the lack of a Member ID card in their possession.

For more information, please see the Medicaid bulletin Confirming Medicaid Coverage for Beneficiaries.


Enrollment and Eligibility Updates, Prepaid Health Plan Flexibility

July 15, 2021

Enrollment and Eligibility Updates Available in NCTracks

Effective July 1, 2021, enrollment and eligibility data was added to NCTracks for managed care (MC). The added information will allow authorized users to search the following:

  • MC Prepaid Health Plan (PHP) provider name
  • MC PHP provider contact information
  • MC Advance Medical Home (AMH) and primary care provider (PCP) name
  • MC AMH and PCP contact information

In addition to the changes made in the NCTracks portal, the corresponding 270/271 companion guide (located on the Trading Partner Information page) has been updated to reflect the additional information. Trading partners and providers are encouraged to review these important updates.

Prepaid Health Plan Flexibility for Prior Authorizations During First 60 days after Managed Care Launch

NCDHHS continued to receive feedback from NC Medicaid providers indicating confusion about prior authorization requirements during the state’s transition to NC Medicaid Managed Care. The Department shared this feedback with the prepaid health plans (PHPs). In response to these concerns, the PHPs will implement the following solution during the first 60 days after managed care launch to ensure beneficiaries continue to have access to services during this transition without unnecessary interruption.

  1. Between July 1 and Aug. 30, 2021, medically necessary services that normally require prior authorization will still be reimbursed at 100% of the NC Medicaid fee-for-service rate for both in- and out-of-network providers.  To ensure that providers fully understand each PHP’s prior authorization requirements during the transition, the PHPs will still process and pay for these services if:
    • a provider fails to submit prior authorization prior to the service being provided and submits prior authorization after the date of service, or
    • a provider submits for retroactive prior authorizations.
      This exception does not apply to concurrent reviews for inpatient hospitalizations which should still occur during this time period.
  2. Beginning Aug. 31, 2021, the PHP may deny payment for services that require prior authorization.  For in-network providers this will apply to those services that normally require prior authorization. Out-of-network providers will need to seek authorizations for all services.
  3. The Department expects all providers to maintain scheduled medical care for beneficiaries through this transition.
  4. The Department expects the PHPs and providers to continue to work to resolve any outstanding contracting barriers during this time to mitigate out-of-network challenges.

Additional details about each PHP’s required authorizations are available here:


NCMB’s Latest Podcast  on the CSRS Mandatory Reporting Requirement from the STOP Act

July 9, 2021

NC Medical Board’s latest podcast episode is on the CSRS Mandatory Reporting requirement from the STOP Act. Jean Brinkley interviewed the person supporting prescribers with training and use of the system. You can find the episode here: https://www.ncmedboard.org/resources-information/multimedia/medboard-matters-podcast/podcast-details/mandatory-use-of-nc-csrs. The link to the show page includes NC CSRS resources.

Lastly, if there’s a topic that would be particularly helpful to your members, please feel free to send along your ideas. One of the things we will be working on this year is to have more input and engagement from licensees and stakeholders – everything from questions and comments (i.e. ‘mail bag’ episode) to specific topic requests. Your members can email us at podcast@ncmedboard.org.


White Coat Investor, Financial Planning Webinar – 7/13

July 9, 2021

Concerned about your finances? Has COVID upended your plans? Dr. James Dahle, The White Coat Investor, has tips for emergency physicians in ALL stages of your career during this July 13 webinar.

Sign up today & ask YOUR specific questions!
www.acep.org/master-calendar/…


Legislative Update for 07/01/21

July 1, 2021

Budget season is in full swing! Republican Senators held a press conference last week to announce their long-awaited budget proposal. Senate Leader Phil Berger explained that their proposal can be summed up in two ways: cutting taxes and constructing the state’s post-pandemic future. In typical Senate speed they revealed their budget and moved it quickly through committees and onto the Senate floor where it was approved by a vote of 32 to 17. Read the full report here.


Hospital Procedure Continuity at NC Medicaid Managed Care Launch

July 1, 2021

NC Medicaid wants to ensure that during the transition to NC Medicaid Managed Care that Medicaid beneficiaries receive the care they need as scheduled prior to July 1. This includes confirming that procedures for care scheduled prior to July 1 continue without interruption.

The Department and the health plans want to give providers the information they need to provide care to beneficiaries and receive reimbursement for the care that is provided. To support this effort, the Department is compiling the following information for hospitals/facilities and providers to make sure that they have the information to maintain their scheduled procedures.

It is critical for hospitals and health systems to share this information broadly and to include their care teams at all levels of the organization, including outpatient facilities and clinics, schedulers, phone centers and individual departments.

Please see the Medicaid bulletin Hospital Procedure Continuity at NC Medicaid Managed Care Launch for information on how the health plans and the Department are supporting hospital procedure continuity at NC Managed Care Launch.


Managed Care Launch

July 1, 2021

Starting today, July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina will begin receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans (see the NCDHHS press release). Most beneficiaries will continue to get care from the same doctors they see today but will now be a member of a health plan. Some beneficiaries will not enroll with health plans and will remain in NC Medicaid Direct.

NCDHHS has leveraged the move to managed care to build an innovative health care delivery system that puts the health of beneficiaries at the forefront. Features of the state’s program include establishing a payment structure that rewards better health outcomes, integrating physical and behavioral health, and investing in non-medical interventions aimed at reducing costs and improving the health of Medicaid beneficiaries. Our goal for Day One of Medicaid Managed Care is that people get the care they need and providers get paid.

Please see the following resources to help with the Day One transition that we encourage you to share with your partners:

More information on NC Medicaid Managed Care can be found on the NC Medicaid website at  medicaid.ncdhhs.gov/transformation.


Medicaid Transformation News: Getting Ready for Medicaid Managed Care

June 29, 2021

With less than a week before the state ‘goes live’ with Medicaid managed care next Thursday, July 1, the NCMS and our partners and other stakeholders are working to make this an easier transition for you and your practice. The NCMS has compiled a helpful list of resources on our Medicaid Transformation page with links to all of the plans and the information they are sharing with Medicaid providers. View the NCMS Medicaid Transformation page.

As with any major change, there are sure to be things that do not go according to plan, and the NCMS and our partners have developed a process we hope will help our members deal with this momentous shift in how services will be delivered to patients covered by Medicaid. We have created a special form where you can log your issues with us. The purpose is to aggregate common complaints so we can communicate with the state and our contacts at each health plan what many members are experiencing. If issues occur, please reach out to the plan first to share your experience. If the issue persists, then you can complete our Medicaid Transformation Issues form.

Stay tuned to your NCMS Morning Rounds and your email for updates on the process to log your issues with us and how we will work to resolve them.

If you have questions that can’t be answered via the plan or the resources on our page, please email us here.


Health Equity Payment Initiative Survey for Medicaid Providers

June 28, 2021

All Carolina Access Providers who received health equity payments are asked to take 5-10 minutes to complete this survey by July 16, 2021. The survey allows DHHS to monitor and evaluate how these payments were used.

Practices receiving enhanced payments must complete a practice survey following this health equity initiative; failure to complete the survey may result in NC DHHS recouping payments.

In March of 2021, NC Medicaid announced the health equity payment initiative, providing certain Carolina Access providers serving Medicaid beneficiaries from high poverty areas of the State enhanced payments for a 3-month period to achieve health equity among North Carolina’s Medicaid population.

The initiative aimed to improve access to primary care and preventive services for Medicaid and NC Health Choice beneficiaries in North Carolina at a time when historically marginalized populations face challenges highlighted during the COVID-19 public health emergency.


CSRS Reporting Mandate Going into Effect July 7

June 21, 2021

A STOP Act requirement to check the NC Controlled Substances Reporting System (NC CSRS) before prescribing certain controlled substances will be in effect as of July 7, NCMB has been advised by the NC Department of Health and Human Services (NC DHHS). Physicians, physician assistants and other controlled substances prescribers who are not already registered and using NC CSRS should register now to ensure they are in compliance by July 7. Read more information here.


Legislative Update for 06/16/21

June 16, 2021

The weeks after the crossover deadline moved slowly as the House and Senate continued their behind the scenes battle about how much the State should spend (not the details, just the number). Things were going nowhere as the House was not moving Senate bills and the Senate was not moving House bills until the House made the bold move to go ahead with the budget process on their own. Speaker Moore made it clear that, with or without the Senate’s proposed budget, the House would begin the budget process and would vote on a budget this session. This announcement seemed to get things moving again and the chambers resolved the final budget spending level so that the Senate can continue their proposed budget. We expect the Senate budget to be rolled out the week of June 21st and the House to roll out their proposal in July. Of course, the Governor still has a veto stamp, that he has shown he is more than willing to use, but probably wondered if he would even have a chance to use it with the Republicans battling themselves. Here are some of the other stories from the last two weeks. Read the full report here.


Legislative Update for 05/29/21

May 29, 2021

It has been a quiet two weeks at the General Assembly following many busy weeks at the legislative building for Crossover. With the gas shortage last week and the budget impasse this week, legislators had very light weeks with very few votes or even committee meetings. We now head into the long Memorial Day weekend, one which is especially loved by politicians of all stripes, as we celebrate the men and women in the armed services and the sacrifices they have made and continue to make for our country.  Although it has been a difficult year and a half, many are welcoming getting back to some sense of normalcy and enjoying the long weekend. We hope that you enjoy yours! Read the full report here.


NCMS Leadership Openings – Applications Due May 15th

April 27, 2021

For all interested, the NCMS is accepting nominations for Board Member at Large and Nominating and Leadership Development Committee members. You may access the Nomination Form here. Applications are due by May 15, 2021.


New Health Policy Scholar Grant Opportunity – Application Deadline is June 11, 2021

April 27, 2021

The Emergency Medicine Foundation and the Emergency Medicine Policy Institute are pleased to release a new funding opportunity, the Health Policy Research Scholar Award.  The goals of the EMPI/EMF Health Policy Research Scholar Award Program are 1) to promote research on health policy affecting emergency care, 2) to  answer topical health policy questions affecting emergency medical care, and 3) to facilitate the academic growth, advanced education, and development of future leaders in emergency care health policy and thereby invest in the future of the specialty of emergency medicine.

Eligible applicants include graduates of an ACGME approved emergency medicine residency or pediatric emergency medicine training program at the beginning of the funding period.

EMPI/EMF encourages applications with a focus on one of the priority areas:

  •          Cost and value of emergency care
  •          Financing and economics of emergency care
  •          Innovation and diversification of emergency care delivery

Access the Request for Proposal at https://www.emfoundation.org/grants/apply-for-a-grant/.


Workforce Taskforce Report Summary

April 15, 2021

On behalf of the ACEP Board of Directors, we are sharing a few important updates on the recent webinar where the findings of the Emergency Medicine Physician Workforce: Projections for 2030 were released and preliminary ideas were presented by the leaders of the Workforce Taskforce member organizations.

It is now the task of all emergency medicine to translate the data from the report and these initial ideas into action plans that will stabilize and strengthen emergency medicine.

From ACEP’s perspective, there are 8 key considerations we are committed to addressing:

  • Stem the growth of emergency medicine residents and residency programs
  • Raise the bar and ensure consistency across emergency medicine residency training
  • Ensure business interests are not superseding the needs of educating the workforce
  • Support practicing physicians to encourage rewarding practice in all communities
  • Advocate that NPs and PAs working in the unique environment of emergency department have sufficient specialty training and work as a member of the emergency physician-led team
  • Set the standards for emergency medicine so every patient has access to a board-certified emergency physician
  • Broaden the umbrella to expand emergency medicine physician scope of practice
  • Expand the reach of emergency medicine to ensure that no community is left behind

There is not one perfect, holistic solution to address market-driven industry instability. Change will take time and precision. Any successes will require the coordinated involvement of the entire specialty, with each stakeholder organization playing a unique role in the process.

Now is time for us to listen as we invite all emergency physicians to share your ideas for solutions. We are inviting ACEP’s chapters and sections to host town hall style discussion forums to talk about next steps. We are encouraging our partner organizations to do the same. Please look for these opportunities to participate and be a part of shaping the next generation of emergency medicine.

If you haven’t already, please watch the recent webinar with the research review and some initial ideas.

Read the Brief Summary prepared by ACEP’s Board for more detail.

Join the ongoing conversation in the Workforce discussion forum or use the workforce@acep.org email address to submit thoughts and ideas.

Lastly, be sure to bookmark this page as we will continue to update you on all efforts across the stakeholder organizations.


Provider Data and Provider Verification Updates

April 14, 2021

NCTracks Changes to Provider Verification Process

Currently, NCTracks sends notifications for expiring credentials (licenses, certifications and accreditations) to all enrolled providers required to be licensed, certified and/or accredited. These notices are sent to the Provider Message Center Inbox beginning 60 days in advance of the expiration date of the credential.

Effective May 9, 2021, NC Medicaid is taking additional steps to ensure providers meet their contractual obligation and responsibility to keep credentials current on their NCTracks enrollment record by making system modifications to begin a process of 45 and 60 day notifications of suspension if a provider fails to update their credential prior to the expiration date on file with NCTracks. Providers were first informed of this forthcoming system modification in March of 2018.

Choosing from providers with complete and up-to-date licensure, certification and accreditation information allows NC Medicaid beneficiaries to make informed choices to achieve the best health outcomes. System modifications alerting providers to update expiring credentials will assist providers in meeting federal and State enrollment and credentialing requirements and will assist NC Medicaid in removing unlicensed providers and expired credentials from provider records. With updated provider information, NC Medicaid will be able to transmit accurate provider data to health plans and other departmental partners who serve Medicaid beneficiaries.

Please see NCTracks Changes to Provider Verification Process for additional information on the timeline for notifications, suspension and termination as well as what happens when credentials expire.

Provider Data Updates

Providing the most accurate and complete provider information is a top priority so Medicaid and NC Health Choice beneficiaries can make the most informed choice for their health plan and primary care provider. NCTracks is the “system of record” for provider enrollment data, which is then shared with health plans to inform contracting and provider directories.

In our review, the primary challenge with accurate data has been encouraging providers to keep their information accurate and current on all applicable enrollment records. If provider information is not current, then the data that flows forward to the health plans and the enrollment broker will not be accurate.

It is critical that all providers take the time now to review their provider records in NCTracks and submit changes as needed using the Manage Change Request (MCR) process.

Please see Provider Data Updates for additional information and resources.


Medicaid Health Plan Meet and Greet

March 16, 2021

With open enrollment underway as of yesterday for Medicaid managed care, if your practice has not yet contracted with one of the pre-paid health plans — or even if you have — here is an opportunity to get your questions answered. NC Medicaid in partnership with NC AHEC will host a series of virtual Health Plan Meet and Greet Sessions beginning next Tuesday, March 23.

Representatives from each of the five contracted health plans will be available to address your concerns and questions about the state’s transition from Medicaid fee-for-service to Medicaid managed care, slated to ‘go-live’ on July 1. Sessions will be delivered live with a recording and transcript made available after each event at NC AHEC’s Medicaid Managed Care webpage. And be sure to check out that page for other learning opportunities as North Carolina gets closer to this major shift in its Medicaid program.

The first session will be for primary care and specialty providers on Tuesday, March 23 beginning with Amerihealth Caritas at 7:45 a.m., followed by Carolina Complete Health at 9:30 a.m.

Learn more and access the links for each session by scrolling to the bottom of NC AHEC’s webpage.


NC Medicaid Enrollment Call Center and Website are Live

March 2, 2021

NCDHHS has begun mailing enrollment packets statewide and launched new resources for beneficiaries as it prepares for NC Medicaid Managed Care Open Enrollment which begins on March 15, 2021. Beneficiaries can now call the NC Medicaid Enrollment Call Center to learn more about NC Medicaid Managed Care and can download a free beneficiary enrollment mobile app. These new tools, as well as the NC Medicaid enrollment website, will assist beneficiaries in choosing a primary care provider (PCP) and a health plan for their families’ care. Some people will not need to choose a health plan because of the type of health services they need.

The NC Medicaid Enrollment Call Center number is 833-870-5500/TTY: 833-870-5588. The free mobile app, called NC Medicaid Managed Care is available on Google Play or the App Store. Mailing of enrollment packets is being done in batches and should arrive at beneficiary homes by Monday, March 15, 2021. Open enrollment officially begins March 15, but beneficiaries can proceed now with online enrollment, or call the NC Medicaid Enrollment Call Center for assistance.


NC Medicaid Help Center Now Available for Providers

March 2, 2021

In addition to the NC Medicaid Provider webpage, Medicaid and NC Health Choice providers now have a supplemental resource to research their questions and submit inquiries. The NC Medicaid Help Center launched today as an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. Formerly referenced as the “SWAT Command Center,” the NC Medicaid Help Center also includes resource documents such as standard and COVID-19 Medicaid Bulletins. A Medicaid bulletin has been posted with more detail.


NCDHHS Transition of Care Policy

February 26, 2021

NC Medicaid is pleased to release the NC Department of Health and Human Services Transition of Care Policy which describes key design features related to maintaining continuity of care for each Member and minimizing the burden on providers during transitions between service delivery systems. Please submit comments and questions about the Policy to Medicaid.NCEngagement@dhhs.nc.gov.

NC Medicaid will host a webinar overview of the TOC Policy on Thursday, March 11, 2021 from 12 noon to 1 p.m.  Please pre-register for the webinar.


Legislative Update for 02/22/21

February 22, 2021

The House passed Senate Bill 37 this week, requiring schools to open following Plan A for special needs students and either Plan A or B for all students. Plan A only requires masks, while Plan B calls for masks and social distancing. The bill still provides for an online option for students throughout the state as well. There has been some controversy with this bill, largely partisan in nature, concerning older students returning with minimal social distancing. House Democrats have responded to these concerns with their own bill, House Bill 112. This bill would allow for school districts to open with Plan A or B for elementary students, and allow middle and high school students to return solely under Plan B. Senate Bill 37 has already passed both chambers however, with three Senate Democrats voting in support and eight House Democrats voting in favor, the bill passing the final House vote with a 77-42 veto-proof margin. While the bill is on its way to the Governor, its fate is unknown. Gov. Cooper said earlier this week that he would not sign the bill unless Republicans agreed to make some changes. However, this doesn’t necessarily mean that the Governor will veto the bill. He may allow the bill to become law without his signature.

Read the full report here.


Legislative Update for 02/15/21

February 15, 2021

The state’s recently released revenue forecast shows that North Carolina has fared relatively well economically throughout the pandemic. The two-year forecast’s expected revenue collections surpass the expectations of May 2020’s forecast by $4.1 billion. The forecast explains this surplus was heavily impacted by an increase in sales tax collections and delayed tax payments; it also suggests that the economic state of North Carolina will continue to improve over the coming years. However, there are still segments of the state’s workforce who are underemployed or unemployed due to this pandemic. Gov. Cooper responded in a statement that “while state revenue is strong, people across our state are still hurting and we must use these funds to help them recover from this pandemic.”

Read the full report here.


Tonight! Webinar: COVID Vaccine Distribution Plan Update

January 5, 2021

Please join Dr. Betsey Tilson, State Health Director and Chief Medical Officer, and other NC DHHS leaders on Tuesday, January 5, 2021 from 6:00 – 7:00 for an update on North Carolina’s COVID-19 vaccine distribution plan and for a Question & Answer session about that plan. E-mail us for login information.


Review of Current COVID-19 Vaccine Plan for NC

January 5, 2021

Based on new federal recommendations issued by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices, the NC Department of Health and Human Services (NCDHHS) updated and simplified the vaccine prioritization plan at the end of last month.

For the latest information, tune in tonight, Tuesday, Jan. 5, from 6 to 7 p.m. when State Health Director and Chief Medical Officer Betsey Tilson, MD, MPH, offers an update on the vaccine distribution plan. Dr. Tilson also will respond to questions during the session. Click here to join the meeting via Zoom. Or to join by phone call (646) 558-8656 and use webinar ID 131 899 801.

North Carolina’s updated phases include:
• Current Phase – Phase 1a: Health care workers fighting COVID-19 and Long-Term Care staff and residents.
• Phase 1b (to begin in early January): Adults 75 years or older and frontline essential workers.
• Phase 2: Adults at high risk for exposure and at increased risk of severe illness.
• Phase 3: Students.
• Phase 4: Everyone who wants a safe and effective COVID-19 vaccination.

Currently there is not enough vaccine for everyone to be vaccinated at the same time, so NCDHHS will open the next phase of vaccinations (1b) in groups, starting only with persons above the age of 75 in order to best manage vaccine dose availability. To see all the groups for Phases 1b and Phase 2, please review this Infographic of Vaccine Phases.

Watch your NCMS Morning Rounds for information on how North Carolinians over age 75 will access vaccinations beginning in early January. For those who engage this population, please consider sharing NCDHHS’ resources below in both English and Spanish to answer patients’ questions.

All vaccine providers are expected to ensure the vaccine is equitably administered within each group. Longstanding and continuing racial and ethnic injustices in our health care system contribute to lack of trust in vaccines, and NCDHHS is focused on building trust with historically marginalized populations. The Department is partnering with trusted leaders and organizations to provide accurate information about the vaccine.

More detailed information is available at yourspotyourshot.nc.gov and in the resources below:
• Infographic of Vaccine Phases (English / Spanish)
• Deeper Dive: Phase 1a (English / Spanish)
• Deeper Dive: Phase 1b (English / Spanish Coming)

Here are additional vaccine resources to share with your staff and patients.
• Flyer on Vaccines (English / Spanish)
• Presentation COVID-Vaccination 101 (English / Spanish)
• Frequently Asked Questions (English / Spanish)

NCDHHS’ Vaccines page is continually updated with more information and resources as they are available at yourspotyourshot.nc.gov. The page is also available in Spanish at covid19.ncdhhs.gov/vacuna.


Update on COVID Vaccine for NC Medical Practices

December 17, 2020

On Tuesday evening, State Health Director Betsey Tilson, MD, MPH and other state officials offered NC physicians and PAs an overview of the state’s plans to administer the COVID-19 vaccine, which began arriving in North Carolina in limited supplies this week. View the slides from the presentation here.

Dr. Tilson began with the caution that the only certainty, at this point, is that there will be glitches. The mantra for the next few months should be ‘Keep Calm and Carry On.’ She thanked those on the call for their flexibility and understanding as the state undertakes the massive work of distributing and administering the COVID-19 vaccine. Dr. Tilson also said she hopes to hold ‘office hours’ next week and in the weeks ahead to answer your questions and give updates on the vaccination rollout. 

Here are some key points, based on common questions NCDHHS has received. The points are outlined in detail in the slide deck, which also includes links to more information and resources.

The vaccine is safe:
• Vaccine development and testing was done according to regular protocols, but at ‘warp speed.’ The administrative process was abbreviated, but there was “no cutting corners on safety and efficacy of the vaccine,” Dr. Tilson said in providing background information for you to allay any fears patients may have about the vaccine’s safety.
• The speed with which this vaccine was developed was partly due to the fact that the RNA technology used in the vaccine was already in the works prior to the pandemic, giving vaccine developers a jump start.
• The vaccine contains no live virus and no stem cells. It is composed of a tiny fragment of genetic material in a lipid envelop. There are no preservatives.

Who can get the vaccine:
• Anyone over age 16.
• There is no data from the clinical trials for pregnant or lactating women, but the vaccine may be offered to them with a discussion of the risks and benefits.
• Anyone who has been previously infected with COVID-19 may receive the vaccine.
• The list of vaccine ingredients is included in the slide deck (slide 11) and anyone with a known allergy to any of the ingredients should not receive it. The severe reactions to the vaccine experienced by several people in the United Kingdom are thought to be related to polyethylene glycol, which is an ingredient in the vaccine.
• Slide 23 outlines the prioritization of vaccination. Outpatient primary care clinicians with high risk of exposure to the virus and who have two or more chronic conditions are in group 1b for vaccination. Outpatient clinicians without chronic conditions who are at high or moderate risk of exposure are in group 2. Because the timing and quantity of vaccine shipments is still unknown, it is difficult to say exactly when these groups will be vaccinated.

Vaccine reimbursement:
• The federal government is paying for the vaccine so there is no cost sharing or charge to patients who receive it.
• Public and private insurance will cover the administrative costs. Medicare/Medicaid is reimbursing for administrative costs at $16. 94 for the first dose and $28.39 for the second dose.

Tracking vaccinations:
• To be considered as a location for vaccine distribution, you must enroll in the COVID-19 Vaccine Management System (CVMS) at this link. Questions about the CVMS may be directed to CVMS-Help@dhhs.nc.gov.

More information on the vaccine for you and your patients is available on the NCDHHS COVID-19 website here.


Office Hours w Drs Tilson and Moore – Friday, December 18th, 12:30 – 1:30

December 14, 2020

Dr. Betsey Tilson, State Health Director and Chief Medical Officer, and Dr. Zack Moore, State Epidemiologist, will hold Office Hours to provide updates on the State’s COVID-19 response and to respond to questions next Friday, December 18th, from 12:30 – 1:30.

In addition to the updates and open discussion, DHHS will provide a brief update on the program for reimbursement for COVID-19 related primary care services for individuals.

Please plan to participate and inform your members. Please send questions in advance to questionsCOVID19forum@gmail.com. E-mail us for login information.


From the NCMB President: Seeking help during the prolonged stress of COVID

December 11, 2020

Please take a moment and review the recent message from Dr. Jonnalagadda acknowledging what a tremendously stressful time this is for medical professionals and encouraging licensees to make self-care a priority. Read her full message here.


COVID-19 Vaccine: What North Carolina Practices Need to Know

December 11, 2020

Mark your calendar: Next Tuesday, Dec. 15, from 6 to 7 p.m., State Health Director Betsey Tilson, MD, MPH, and other state health experts will hold a Zoom webinar for health professionals on North Carolina’s plan for the COVID-19 vaccine distribution. E-mail us for login information.

Today, Thursday, Dec. 10, the Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee, which is made up of a group of independent medical experts, will meet to discuss the risks and benefits of the Pfizer/BioNTech COVID-19 vaccine. The goal of the daylong meeting is to make a recommendation on whether the FDA should grant Emergency Use Authorization for the vaccine. The FDA does not have to follow the committee’s recommendations, but usually does. Several media outlets have reported that a decision on the vaccine EUA approval will be made within four days of today’s meeting and vaccine distribution would likely take place within the week.

Here is the agenda for the meeting, which begins at 9 a.m. The meeting is open to the public and you can learn more and listen in at this link.

If you would like to learn more about the results of this vaccine’s clinical trials, you can access the FDA Briefing Document here.

A similar meeting for Moderna’s vaccine candidate is scheduled for next Thursday, Dec. 17.


Get Some Answers on the COVID-19 Vaccine

December 8, 2020

The NC Department of Health and Human Services (NCDHHS) is planning a statewide physician update on the COVID-19 vaccine that will be hosted by NC AHEC on Tuesday, Dec. 15 at 6 p.m. Be sure to mark your calendar and watch your NCMS Morning Rounds in the coming days for updates on agenda and registration links.

Distribution of the vaccine will begin with health systems and physician practices likely will be able to register to administer the vaccine later this month.

NCDHHS has provided a list of basic FAQs about the vaccine on its website including some information about proper storage of the various vaccines. Access that information here.


Stakeholder Calls Information: CMS Atlanta: IFC-4, COVID-19 Vaccine Toolkits, and Listening Session Invitation

November 11, 2020

CMS Atlanta is hosting two calls for stakeholders on Thursday, November 12, 2020 to further discuss the new regulations related to COVID-19 issued on October 28, 2020..  We strongly encourage you to review the IFC and toolkits prior to the conversation and look forward to hearing your feedback.

The following IFC resources are also available:

E-mail us for login information.


Launch of NC Medicaid’s Enrollment Website

November 9, 2020

DHHS has announced the launch of NC Medicaid’s enrollment website, www.ncmedicaidplans.gov, in preparation for the launch of Medicaid Managed Care scheduled for July 1, 2021. Medicaid Managed Care open enrollment will begin March 15, 2021, and will continue through May 14, 2021.

The purpose of the enrollment website is to help Medicaid beneficiaries learn more about Medicaid Managed Care. In 2015, the NC General Assembly enacted legislation directing NCDHHS to transition Medicaid and NC Health Choice from a primarily fee-for-service delivery system to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.

The enrollment website provides information about who will have to choose a health plan, who will stay in the traditional Medicaid program (NC Medicaid Direct) and who can choose between the two. It will also share the basic medical and behavioral health benefits that are offered. There will be a list of frequently asked questions and answers to help beneficiaries understand the changes.

Most people currently receiving Medicaid benefits will need to enroll in Medicaid Managed Care. Medicaid beneficiaries will be able to choose from five health plans — WellCare, United HealthCare, Healthy Blue, AmeriHealth Caritas and Carolina Complete Health (serving regions 3, 4 and 5). Those who are federally recognized tribal members or qualify for Indian Health Services are exempt from managed care. Those who live in Cherokee, Graham, Haywood, Jackson or Swain counties or in a neighboring county may choose to enroll in the Eastern Band of Cherokee Indians (EBCI) Tribal Option.

A small number of people will not need to choose a Medicaid Managed Care health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. To learn more, beneficiaries can visit the NC Medicaid Direct services page on the enrollment website.

To learn more about North Carolina’s transformation to Medicaid Managed Care, visit the Medicaid Transformation webpage.


Office Hours w Drs Tilson and Moore – Friday, November 6th, 12:30 – 1:30

November 4, 2020

Dr. Betsey Tilson, State Health Director and Chief Medical Officer, and Dr. Zack Moore, State Epidemiologist, will hold Office Hours to provide updates on the State’s COVID-19 response and to respond to questions this Friday, November 6th, from 12:30 – 1:30.

Please plan to participate and inform your members. Please send questions in advance to questionsCOVID19forum@gmail.com.

E-mail us for login information.


Office Hours w Drs Tilson and Moore – Friday, October 25th, 12:30 – 1:30

October 19, 2020

Dr. Betsey Tilson, State Health Director and Chief Medical Officer, and Dr. Zack Moore, State Epidemiologist, will hold Office Hours to provide updates on the State’s COVID-19 response and to respond to questions this Friday, October 23, from 12:30 – 1:30.

In response to feedback during their last Office Hours, they announced that they will hold Office Hours on the first and third Fridays of the month for the remainder of this year.

Please plan to participate and inform your members. Please send questions in advance to questionsCOVID19forum@gmail.com. E-mail us for login information.


Financial Recovery Program

October 15, 2020

The North Carolina Medical Society Foundation (NCMSF) is proud to oversee the state-funded Financial Recovery Program (FRP) to assist eligible practices throughout the state that are experiencing economic distress due to the pandemic.

Funding will be based on reimbursement for COVID-19-related expenses incurred between March 1 and Nov. 30, 2020.

Read more information here.


Lunch and Learn Webinar – The Financial Recovery Program

October 12, 2020

The Financial Recovery Program (FRP): How Independent Practices Can Apply to Receive Covid-19 Relief Funds featuring Franklin Walker, MBA, Vice President of Rural Health Systems Innovation, NCMS, and Reynold Yordy, Co-founder of Greenlight Ventures

Tuesday, October 13, 2020 |  12:00 pm to 1:00 pm

Learn more about this newly launched state-funded program, which is overseen by the North Carolina Medical Society Foundation and seeks to distribute grants to independent medical practices that have suffered financially due to the Covid-19 pandemic. Learn what the criteria are for applying and how your practice can benefit from the FRP.

VISIT OUR SITE for details on the FRP’s requirements and eligibility:

https://www.ncmedsoc.org/financial-recovery-program/

Register here: https://attendee.gotowebinar.com/register/3904952240085465356

Presented by the North Carolina Medical Society Foundation in cooperation with the North Carolina Medical Group Management Association.

This webinar is free but you must be registered to attend. Space is limited so register early!

 After you register, you will receive an emailed confirmation with webinar and phone-in instructions.


Financial Recovery Program

October 12, 2020

Today is the official launch of the Financial Recovery Program run through the NCMS Foundation. Here is information on the program. Embedded in the document are links to the FRP webpage, the application portal and the email address for questions. Here are those links for your reference:

FRP webpage: https://www.ncmedsoc.org/financial-recovery-program/

FRP application portal: https://frp.ncmedsoc.org/

Email address for questions: FRPNCMS@ncmedsoc.org

A list of FAQswill be a dded to the webpage shortly. This will be a dynamic document as we get questions and will be updated regularly. If you have any questions about practice eligibility or eligible expenses, please contact Franklin Walker.

Applications for these funds are now being accepted. The timeframe to distribute the money is short (Nov. 30 is the deadline). Please spread the word widely. We want to be sure to get this funding to those who need it!


Office Hours w Drs Tilson and Moore – Friday, October 9th, 12:30 – 1:30

October 5, 2020

Dr. Betsey Tilson, State Health Director and Chief Medical Officer, and Dr. Zack Moore, State Epidemiologist, will hold Office Hours to provide updates on the State’s COVID-19 response and to respond to questions this Friday, October 9th, from 12:30 – 1:30. They will also hold Office Hours on Friday, October 23, from 12:30 – 1:30.

Please plan to participate and inform your members. Please send questions in advance to questionsCOVID19forum@gmail.com. E-mail us for login information.


Health Care Professionals Series to Address Medicaid Transformation

September 30, 2020

The next installment of the “Health Care Professionals Webinar Series” will run this Thursday, October 1, from 5:30 p.m. to 6:30 p.m. and will continue on the first Thursday of every month.

This series will focus on Managed Care and be hosted by Dr. Shannon Dowler, Chief Medical Officer, NC Division of Health Benefits and moderated by Hugh Tilson, Director, NC AHEC Program.

Thursday’s topic is Better with Time: Medicaid Transformation State of Things.

This webinar will focus on:

  • Managed Care 101: Reminders and Timeline
  • Get to Know Your CMOs
  • What You Can Do NOW to be Ready LATER
  • Medicaid Hot Topic Updates
  • Q & A

Click here to register!


Research Survey Study: PTSD Symptoms in ED Physicians during COVID-19

September 28, 2020

Duke University, in collaboration with the ACEP Wellness Section, is looking for physicians working in Emergency Departments across the United States to participate a research study entitled “Prevalence & Predictors of PTSD Symptoms among Emergency Physicians in the United States during the COVID-19 outbreak.” Participation in this study is voluntary.

Eligibility Criteria:
·       US Board-Certified/Board-Eligible Emergency Medicine Physician
·       Emergency Medicine Resident in the United States
·       US Non-EM Physician working in an EM setting

The purpose of this study is provide information about the prevalence of Post-Traumatic Stress Disorder (PTSD) symptoms among Emergency Medicine physicians nationwide in the United States following the COVID-19 pandemic, and to explore other related factors including predictors of these symptoms.

If you agree to participate, you will be asked to complete a survey about your experiences as an Emergency Room physician during the COVID-19 pandemic. This survey may contain questions that are sensitive or upsetting. You may skip any questions that make you uncomfortable or that you do not wish to answer. No information that can identify you will be collected and your name and contact information will not be linked with the survey results. This survey should take you about 10 minutes to complete.


Special Bulletins Update

September 23, 2020

NC Medicaid is committed to ensuring beneficiaries continue to receive Medicaid and NC Health Choice services with no interruptions or delays due to COVID-19. In August, NC Medicaid released SPECIAL BULLETIN COVID-19 #119: NC Medicaid Extends Temporary Clinical Coverage Policy Provisions and Temporary Rate Enhancements, which provided information on extensions of the COVID-19 rate enhancements and Clinical Coverage Policies in response to the extension of the federal Public Health Emergency declaration.

SPECIAL BULLETIN COVID-19 #134: Clarification of COVID-19 Temporary Rate Increases and Clinical Policy Changes clarifies and further updates information provided in Special Bulletin 119.


NCMB Launches MedBoard Matters Podcast

September 21, 2020

NCMB has announced the launch of their podcast, MedBoard Matters. The podcast will highlight important issues in medicine and medical regulation. The goal is to present compelling content in an easy-to-digest and enjoyable format. The very first episode is on suicide prevention awareness. Jean Fisher Brinkley had a great and uplifting conversation about a very heavy topic with Dr. Christine Moutier, Chief Medical Officer for the American Foundation for Suicide Prevention. Dr. Moutier discusses ways to overcome stigma associated with mental health issues in medical professionals and strategies and resources for getting help – as well as what to do if a colleague is in crisis.

The episode has been published in recognition of Physician Suicide Awareness Day, September 17th.

Here is a link to the episode: https://www.buzzsprout.com/1230689/5455090. We hope that folks will subscribe by searching for “MedBoard Matters” on their podcast platform of choice so they can be notified of future episodes.

If NCCEP members have questions they have always wanted to ask the Board, or ideas for specific topics for future episodes on MedBoard Matters, we would love to get feedback! Send suggestions and questions to podcast@ncmedboard.org.


NCDHHS-Covered Services Available to Help NC Residents Isolate or Quarantine

September 14, 2020

Please review the fact sheet outlining the new NC DHHS COVID-19 Support Services Program and Community Health Worker Initiative as announced in late August (press releases are available online here and here). This document provides an overview of NCDHHS-covered services and the community health worker program in target counties, including:

  • What are the CHW and Support Service programs
  • What support services are available at no cost to individuals
  • Who is eligible for support services
  • How you play a role in connecting residents to support
  • Who to contact for more information

We urge you to send this around your organization to ensure our partners have the most updated information and can refer our residents to the support they need to quarantine and isolate safely and effectively.


Firearm Injury Surveillance Through Emergency Rooms (FASTER) Award Recipients Announced

September 11, 2020

North Carolina is participating in the FASTER program. See more information below:

The CDC’s Division of Violence Prevention announces funding to 10 state health departments to gather surveillance data in near-real time on emergency visits for nonfatal firearm injuries. This competitively awarded funding falls under CDC-RFA-CE20-2005, Firearm Injury Surveillance Through Emergency Rooms (FASTER).

CDC awarded a total of $2,224,482 distributed among 10 recipients:

  • District of Columbia Department of Health
  • Florida Department of Health
  • Georgia Department of Health
  • New Mexico Department of Health
  • North Carolina Department of Health and Human Services
  • Oregon Health Authority
  • Utah Department of Health
  • Virginia Department of Health
  • Washington State Department of Health
  • West Virginia Department of Health and Human Services

Timely state- and local-level data on ED visits for nonfatal firearm injuries are currently limited. The collection of near-real-time data on ED visits for nonfatal firearm injuries overall and by intent (intentional self-directed, unintentional, and assault-related) at the state and local level could improve state and local practitioners’ ability to identify and respond to emerging public health problems.

The goal of this award is for recipients to improve the timeliness and dissemination of surveillance data of ED visits for nonfatal firearm injuries. Collaboration among states will include sharing data to strengthen syndrome definitions, data collection methods, analysis of surveillance data, and presentation and dissemination of findings.

Additionally, this collaborative award will result in tools and methods that can be used by state and local health departments across the nation to rapidly track and respond to firearm injuries.

Learn More

CDC’s Division of Violence Prevention 
Firearm Violence Prevention 


Announcement to NC Medicaid Associations

September 3, 2020

NC Medicaid is reimbursing COVID-19 testing costs for individuals without insurance who enroll in the NC Medicaid Optional COVID-19 Testing (MCV) program. This option was made available to all states through Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA). Enrolled MCV beneficiaries will also qualify for coverage of COVID-19 tests retroactive to June 1, 2020 provided they were uninsured at the time of the test.

To qualify, individuals must be uninsured, a resident of North Carolina, and meet the citizenship and legal immigration status requirements of the Medicaid program. NC Medicaid is required to verify citizenship and immigration status. Individuals must qualify for MCV at the time the test was obtained.

SPECIAL BULLETIN COVID #128: NC Medicaid Optional COVID-19 Testing Program Online Applications Available and a fact sheet describe the program in more detail. Additionally, a one-page flyer/signage is designed to help raise awareness of this program at testing locations, practices, clinics, health systems, Departments of Social Services and any organization that sees uninsured residents. The fact sheet and flyer are available at: https://medicaid.ncdhhs.gov/about-us/covid-19-guidance-and-resources/providers.