From NC Medicaid:

Some private and commercial insurers already require these codes, so providers should check with their billing team to review relevant protocol. These F codes are required by NC Medicaid’s clinical policy and apply to all delivery claims (not just those that are globally billed).

NC Medicaid urges providers to begin using the new codes as soon as possible. After July 1, 2025, Medicaid claims for delivery will deny if 0500F is not in the patient's history. This change will apply to both NC Medicaid Managed Care and NC Medicaid Direct claims.

Details and Source: New F Codes: Capturing Prenatal and Postpartum Care Services

NEW WEBINAR SERIES

MEDICAID MANAGED CARE

Disaster Preparedness for Members with Chronic Conditions

June 12, July 15 and August 19

NOON - 1 p.m.

Please join us for a new webinar series focused on disaster preparedness for members with chronic conditions. This series will cover topics such as:

• Overview of Disaster Preparedness in North Carolina 
• Understanding At-Risk Medicaid Populations 
• General Preparedness for High-Risk Members 
• Condition-Specific Considerations 
• Sheltering in Place vs. Evacuation 
• Special Considerations for Populations with Disabilities 
• Behavioral Health and Substance Use Disorder Preparedness 
• Building Resiliency and Promoting Equity 

The first webinar will take place on June 12, 2025, followed by July 15 and August 19. Register for this series by clicking on the button below. We look forward to connecting with you!

The Center for Medicare and Medicaid Services (CMS) has announced it is suspending eight improvement activities for the 2025 performance year.

The suspension is in accordance with the Merit-based Incentive Payment System (MIPS) Improvement Activities Suspension Policy finalized in the CY2021 Physician Fee Schedule final rule.  CMS intends to propose removing these improvement activities in future rulemaking.

MIPS Improvement Activities Suspended for PY 2025

CMS says that clinicians should select other improvement activities to complete.  However, if any of the suspended improvement activities have already been completed or were in the process of being completed, clinicians will still be able to attest to completing them and receive credit.  Please review the 2025 Improvement Activities Inventory for available improvement activities.

Visit the QPP website for more information.

Source: Improvement Activities Suspension Announcement, Small Practices Newsletter, 2025

The Practice Manager Boot Camp is designed to provide new practice managers with the information they need to run their practices effectively, for experienced managers seeking refresher training or to learn new skills, and for staff members with practice management or leadership responsibilities.

The next cohort for this virtual program begins on July 17,2025 and registration fee discounts are available for early registration.

Divided into a total of 36 on-hour sessions within nine separate modules, participants can choose to either register for the full boot camp  (with a 25% discount on the full registration fee), or for individual modules within it. 

The courses meet via live webinar on Thursday afternoons from 3:00-4:00 PM and are recorded for later viewing.

Learn more about the boot camp and individual modules.

If you have any questions, contact Jane Moran at jane.moran@sr-ahec.org!

Most eligible children will automatically qualify for the program and were auto enrolled by May 2, 2025. Children automatically qualify if they are eligible for any of the following programs: 

• Free and reduced-price (FRP) meals at schools by approved FRP application
• Food and Nutrition Services (also called FNS or food stamps)
• Temporary Assistance for Needy Families (TANF)
• Cherokee Tribal Food Distribution Program (CTFDP)
• Child is in Foster Care
• Child is enrolled in the McKinney-Vento program (experiencing homelessness or runaway)
• OR if they receive NC Medicaid benefits and have a household income below 185% of the federal poverty level

Families with children who qualify will receive a new 2025 SUN Bucks card in the mail.  

Families with questions can visit the website at ncdhhs.gov/sunbucks or call the NC SUN Bucks Call Center at 1-866-719-0141, select a language, then select option 2 to speak with a SUN Bucks representative.

See the full Press Release from NCDHHS to learn more.

Webinar Series

CHW Integration: Strategies for Impact and Sustainability

You're invited to a two-part webinar series, CHW Integration: Strategies for Impact and Sustainability, focused on advancing and sustaining Community Health Worker (CHW) integration across North Carolina’s healthcare system. 

Hosted by NC AHEC, the North Carolina Community Health Worker Association (NCCHWA), and Freedmen’s Consulting, this series will explore strategies to strengthen CHW programs, align them with value-based care models, and support long-term sustainability through practical financing approaches.

These sessions are designed for CHWs, community-based organizations, healthcare practices, care management agencies, health system population health teams, and health plans. 

This event is sponsored by NC Division of Health Benefits (Medicaid) at no cost to participants. 

Part 1: May 19, 2025 | noon - 1 p.m. | REGISTER

Explore how CHWs are driving improvements in population health, enhancing care experiences, and helping to reduce costs. As healthcare moves from fee-for-service to value-based care, CHWs are becoming essential partners in delivering whole-person, community-centered care.

Tim P. McNeill, RN, MPH, will lead this session, highlighting the evolving role of CHWs and sharing promising models of integration from Alabama, New York, and Texas.

Part 2: June 4, 2025 | noon - 1 p.m. | REGISTER

Learn how financing strategies can support and sustain CHW integration across healthcare settings. As value-based care continues to expand, understanding how to fund and grow CHW programs is critical.

Tim P. McNeill, RN, MPH, will review current payment models and discuss their effectiveness in supporting CHW roles. This session includes a care transitions case study and tools to help develop a sustainable CHW integration strategy.

We hope you'll join us for one or both sessions! For questions about NC AHEC CHW Program, please visit our webpage .

From the North Carolina Office of Rural Health:

The Office of Rural Health (ORH) offers qualifying physicians, with educational (student) loan debt, incentive payments to repay their loans tax-free through the Primary Care Physicians Initiative (NC PCPI). With the passage of Session Law 2023-134, incentive payments are awarded to eligible physicians in exchange for providing comprehensive primary care services in outpatient settings at eligible sites serving those with highest need located within Tier 1 and Tier 2 of the North Carolina's County Distress Rankings (Tiers).

Funding is limited and the awards will be based on a first-come, first-served basis for eligible and complete applications. ORH anticipates up to 16 awards in each of the six Medicaid Regions. The application portal will not accept more than 20 applications per Medicaid Region. 

Applicants are strongly encouraged to review the guidelines carefully and gather necessary documentation so that they are prepared to complete the online application in its entirety via the application portal.

MEDICAID MANAGED CARE BACK PORCH CHAT

Key NC Medicaid Updates

Thursday, May 15 | noon-1 p.m.

Please join this month's Back Porch Chat on Thursday, May 15 from 12-1 p.m. This webinar will be hosted by Dr. Janelle White, Chief Medical Officer of NC Medicaid, and will cover important federal updates and NC Medicaid budget priorities.

Additional topics include:

• Clinical Coverage Request Process and Policy Revision Request Process
• 2024 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Results
• Credentialing Committee Updates
• Justice-Involved Reentry Work

Register by clicking the blue button below. We look forward to connecting with you!

Today we share with you a recent communication from North Carolina Medicaid. Your feedback can help shape the 2026 Standardized AMH Performance Incentive Program.

MEMORANDUM

The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than 2 million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid enrollees and their families. 

Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures; however, provider feedback and formal PHP reporting indicate that approach to these arrangements varies widely among PHPs. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans and to focus and align their quality improvement efforts for Medicaid members.   

To address these challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input. 

Standard Plans and Tailored Plans would be required to offer this program to all AMHs. Participation in the program is optional for AMH practices, and PHPs and AMHs may agree to other Value-Based Payment models in addition to or in lieu of this program, if desired. 

The AMH Standardized Performance Incentive program was developed as a feature of North Carolina’s participation in the Centers for Medicare & Medicaid Services (CMS) Making Care Primary (MCP) model. CMS recently announced the MCP model will be ending early by Dec. 31, 2025, nine years earlier than planned. While the Medicare MCP model will not be continuing, the Department’s proposed AMH Standardized Performance Incentive program remains an important step to advance NC Medicaid’s goals of reducing provider burden and improving health outcomes.

NC Medicaid is seeking additional feedback from community partners on the design of the AMH Standardized Performance Incentive Program and will continue to meet and collaborate with community partners and CMS in the consideration and design of this proposal. 

Community partners are encouraged to provide feedback on the draft AMH Standardized Performance Incentive Program Policy Guide by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “AMH Standardized Performance Incentive Program Feedback”) by April 21, 2025.