Each PHP has designed communications to keep Providers updated on policies and processes, clinical guidelines, state regulatory changes, federal regulatory changes, and other issues affecting your practice and patients. Please review PHP newsletters and communications frequently to stay up to date on the latest information.

*Denotes subscription to communication is available on the webpage.

HEALTHY BLUE NC

• Newsletters: https://provider.healthybluenc.com/north-carolina-provider/communications

AMERIHEALTH CARITAS NORTH CAROLINA

• Newsletters/Updates: https://www.amerihealthcaritasnc.com/provider/newsletters-and-updates/index.aspx

CAROLINA COMPLETE HEALTH

• Bulletins/Newsletters: https://network.carolinacompletehealth.com/ProviderUpdates/cchn-bulletins-and-newsletters.html 
• Updates: https://network.carolinacompletehealth.com/ProviderUpdates/ProviderUpdates.html 
• Medicaid Transformation Updates: https://network.carolinacompletehealth.com/ProviderUpdates/medicaid-transformation-updates.html

WELLCARE

• Newsletters: https://www.wellcare.com/en/North-Carolina/Providers/Newsletters

UNITED HEALTHCARE COMMUNITY PLAN

• Network Bulletin* (State and Regional information at bottom of page.): https://www.uhcprovider.com/en/resource-library/news/network-news.html

PHP CLAIMS ISSUES TROUBLESHOOTING STEPS

Note: 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. Follow the steps in this Medicaid bulletin when an NC Medicaid or NC Health Choice member presents at your office.

UnitedHealthcare has recognized that FQHC claims have been adjudicating inappropriately since July 1, 2021. Recently you may have experienced T1015 claims, with the below reason code:

• A12, 1427 –  FQHC services need to be billed under the FQHC provider information with the T1015 code or the appropriate billing CPT, not the individual practitioner. 

Submitted claims with these reason codes are being reprocessed and will be paid appropriately. UHC is monitoring the claims daily, and they expect the volume of claims to subside with this remark code beginning soon. Providers do not need to resubmit the claims at this time.

• How to Request Free PPE from NCDHHS:  Requesting PPE | NC COVID-19 (ncdhhs.gov)
• Updated View or Print Your COVID-19 Vaccine Information
• 99401 COVID Vaccine Counseling Code Tip Sheet

ACCELERATED AND ADVANCE PAYMENTS

COVID-19 Accelerated and Advance Payments: Updated FAQs:  Centers for Medicare and Medicaid Services (CMS) updated FAQs (PDF) about repayment of COVID-19 accelerated and advance payments. If you got these payments, learn more about how recoupment works and how it affects your Medicare claims payment amounts. 

More Information:  COVID-19 Accelerated and Advance Payments webpage; Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021 (PDF) MLN Matters Article

ADDITIONAL DOSES: CODES AND PAYMENT

The FDA amended the emergency use authorizations (EUAs) for both the Pfizer BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine to allow for an additional dose in certain immunocompromised people.
 
Effective August 12, 2021, Centers for Medicare & Medicaid Services (CMS) will pay to administer additional doses of COVID-19 vaccines consistent with the FDA EUAs, using CPT code 0003A for the Pfizer vaccine and CPT code 0013A for the Moderna vaccine. CMS will pay the same amount to administer this additional dose as paid for other doses of the COVID-19 vaccine (approximately $40 each).
 
CMS will hold and then process all claims with these codes after completed claims system updates (no later than August 27).
 
Learn more about Medicare COVID-19 vaccine:

• COVID-19 Vaccine Codes
• Payment

• Monday Corner: Medicaid Managed Care and COVID-19 (8/9)
• August Newsletter
• Monday Medicaid Managed Care Corner (7/26)