Latest Information on the E&M Commercial Reimbursement Policy

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Latest Information on the E&M Commercial Reimbursement Policy

BCBS of NC recently published an update explaining the E&M commercial reimbursement policy related to the reduction in payment of Problem Oriented Evaluation and Management Related Services when submitted on the same date as a Preventive Medicine or Annual Wellness encounter.  The new policy will be effective as of September 8, 2022. 

Due to technical issues claims submitted for dates of service between June 1, 2021 and September 7, 2022 will not be subject to the updated E&M commercial reimbursement policy. Claims submitted for dates of service September 8, 2022 and beyond will process in alignment with the updated policy.

If you have received a request for recoupment, please disregard at this time. If you have submitted a refund in response to a request from BCBS, more details will be shared soon on the process for reversing your payment. 

Click here for more information.

Medicaid Managed Care Updates

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Medicaid Managed Care Updates

1. Effective April 1, Medicaid will extend coverage for pregnant women to 12 months after birth. See announcement Here.

2. Medicaid Standard Plans are required to conduct at least two PIPs annually, which must be approved by the Department of Health Benefits. The State may also mandate PIPs to support statewide priorities. The State has determined the following as the 2022 required PIPs:

  • Childhood Immunization Status (CIS) Combo 10 – Tip Sheet
  • Hemoglobin A1c Testing – Tip Sheet
  • Timeliness of Prenatal Care – Tip Sheet Coming Soon

3. An important reminder that Medicaid beneficiaries have Value Added Services available through their health plan that can be beneficial in helping patients better adhere to their care plan and contribute to improvements when addressing these Quality Improvement Initiatives.

To view NC provider Medicaid managed care trending topics following this link.

Provider Resource Requirements

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Provider Resource Requirements

1. The North Carolina Medical Board (NCMB) is now a paperless organization and rarely sends snail mail. To ensure that NCMB messages reach you, update or verify your information utilizing these steps.

2. Were you successful with getting signed up for the NCDAVE System? All clinicians in NC should register with NCDAVE. Register for NCDAVE today

Financial Sustainability Training Events

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Financial Sustainability Training Events

A Primer for Practice Managers

  • Part 1 Highlights Strategic Planning, Budgeting, and Financial Reports with Key Performance Indicators.
  • Part 2 includes education on Effective Payer Management, Revenue Cycle Management, and how to conduct a financial projection for a new program or service.

Tailored Care Management Trainings

NC AHEC has partnered with the NC Department of Health and Human Services and Division of Health Benefits to equip Tailored Care Management (TCM) candidates with the tools and knowledge to effectively provide care management services to North Carolina’s Tailored Plan beneficiaries through Continuing Professional Development (CPD) opportunities.

Find more training opportunities

Prepaid Health Plan Information Added to NCTracks Automated Voice Response System

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Prepaid Health Plan Information Added to NCTracks Automated Voice Response System

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.

NCTracks Home Page

Practice Support Services is Transforming Healthcare Delivery

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Practice Support Services is Transforming Healthcare Delivery

Southern Regional AHEC Practice Support team is committed to helping providers in our region. The SR-AHEC Region consists of the following Counties: Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, Richmond, Robeson, Sampson, and Scotland. We are committed to helping providers meet national standards and ready themselves for valued based care. Health care practices in North Carolina face many challenges. Our team is trained to work with you to transform the way in which care is delivered in your practice. Take your role and practice to the next level with any or all of these eight FREE on-demand courses. This series includes self-paced online courses designed for medical assistants and other members of your team.

The courses include the following:

  1. Improving Office Systems
  2. Introduction to Team-Based Care
  3. Chronic Condition Overview Part 1 – Hypertension & COPD
  4. Chronic Condition Overview Part 2 – Diabetes & Heart Failure
  5. Introduction to Motivational Interviewing
  6. Health Literacy & Patient Education
  7. Recovering Recovery in Mental Health, Substance Abuse & Chronic Illness Details

Link to SR-AHEC Application

Our Practice Support Coaching Team Offers Support for Transitioning to Medicaid Managed Care

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Our Practice Support Coaching Team Offers Support for Transitioning to Medicaid Managed Care

“Medicaid Transformation” The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC are offering an evening webinar series to help prepare providers, practice managers, and quality managers for MMC which is going live July 1, 2021. These webinars are hosted by Shannon Dowler, MD, Chief Medical Officer of the NC Division of Health Benefit. The series will feature various subtopics on Medicaid Managed Care on the first Thursday of each month, Advanced Medical Homes on the second Thursday of each month, and clinical quality on the third Thursday of each month through June 2021. Topics will be listed as they become available. LINK

Other resources for Medicaid Managed Care for Providers, Practice Managers and Quality Managers

Link to Provider Playbook

COVID-19 Information, Education, and Resources

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COVID-19 Information, Education, and Resources

Southern Regional AHEC Practice Support staff will support community-based efforts for COVID-19. Our staff has begun teleworking and utilizing technology to conduct encounters with clinicians and practice staff.

We remain fully committed to supporting our community of clinicians and practice staff through this virtual outreach. Our practice support coaches will continue to provide services for you during the pandemic.

Additional educational resources on COVID-19 or practice support

Link to testing site

Link to vaccine location

Billing tip sheets