On Monday May 10, 2021, the FDA amended the December 11, 2020 emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine authorized for use in adolescents 16 or older to include adolescents 12 -15 years of age. The FDA has determined that Pfizer-BioNTech COVID-19 Vaccine has met the statutory criteria to amend the EUA, and that the known and potential benefits of this vaccine in individuals 12 years of age and older outweigh the known and potential risks, supporting the vaccine’s use in this population.
In December 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Quality Payment Program Final Rule that includes the new MIPS Promoting Interoperability Health Information Exchange Bi-Directional Exchange (PI_HIE_5) measure. 
This measure allows eligible clinicians or groups to attest that they are engaged in bidirectional exchange with an HIE to support transitions of care as an alternative to meeting the Support Electronic Referral Loops by Sending Health Information AND the Support Electronic Referral Loops by Receiving and Reconciling measures (PI_HIE_1 and PI_HIE_4).
Learn more about how to meet this measure at the NCHIEA Teletown Hall on Wednesday, May 26, 2021, at 12 p.m.
Practice Consultant Terri Roberts from Area Health Education Centers (AHEC), will discuss: the new QPP/MIPS measure; its meaningfulness to practices; and how NC HealthConnex can help with attestation.
Register Here [hiea.nc.gov]
Pediatric Practices who have not already signed up for the COVID-19 Vaccine Management System (CVMS) should have received an email from the North Carolina Department of Health and Human Services (NC DHHS) with important updates on the COVID-19 vaccine program. See below for more details.
The Advanced Medical Home webinar series provides Medicaid primary care practice staff and clinicians with more information on North Carolina’s AMH model and how to function at the highest AMH Tier possible when Medicaid Managed Care goes live in July 2021. This webinar, the last in this series, will provide a review of the Advanced Medical Home requirements, update on the glide path payments and more.
THURSDAY, MAY 13 | 5:30–6:30 PM
Advanced Medical Home Refresher
The Northwest AHEC Practice Support Team is committed to promote understanding and improve the orientation of Social Determinants of Health (SDOH) for North Carolinians. In order to support these goals, we will share a publication on SDOH each month on our Practice Support Blog. .png?width=300&name=SDOH%20(1).png)
The social determinants of health, or the areas in which people are born, grow, work, and age, have a profound impact on health. This month we are highlighting the article Screening for Social Determinants of Health in Free and Charitable Clinics in North Carolina.
This publication summarizes findings by Wake Forest Baptist Health researchers Deepak Palakshappa, MD MSHP, Mark Scheerer, Charles Thomas Alexander Semelka, MD, and Kristie L. Foley, PhD. Utilizing a web-based survey, this research team examined free and charitable clinics level of participation in screening for Social Determinants of Health among their 80,000 uninsured and underinsured patient population. The article examines how they can address the needs of patients even more effectively.
The article describes in detail the survey used to collect the data, how the responses were obtained and the final analysis of the data that was received. In addition to the methods of the study, the article details what the authors and researchers learned from the results. Although the results represent findings from a small sample of North Carolina free and charitable clinics, it’s findings reveal a microcosm of the barriers facing the healthcare system and how it can slowly but surely address the needs of all people.
Source:
Palakshappa D, Scheerer M, Semelka CT, Foley KL. Screening for Social Determinants of Health in Free and Charitable Clinics in North Carolina. J Health Care Poor Underserved. 2020;31(1):382-397. doi: 10.1353/hpu.2020.0029. PMID: 32037338. https://pubmed.ncbi.nlm.nih.gov/32037338/
Full text article - https://muse.jhu.edu/article/747795
Pediatric Practices who have not already signed up for the COVID-19 Vaccine Management System (CVMS) should have received an email from the North Carolina Department of Health and Human Services (NC DHHS) with important updates on the COVID-19 vaccine program. See below for more details.
Read More
The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC are offering a bimonthly evening webinar series to help prepare providers, practice managers, and quality managers for Medicaid Managed Care going live on July 1, 2021.
New Resources are Now Available on the QPP Resource Library
NCDHHS has produced a Direct/Manged Care PCP enrollee report to assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program. NCDHHS generated the new Advanced Medical Home (AMH) NC Medicaid Direct/NC Medicaid Managed Care Primary Care Provider (PCP) Enrollee Report for distribution to CCNC/CA participating providers.
The report, initially made available on March 15, 2021, is delivered each month to the NCTracks Secure Provider Portal Message Inbox the Monday before the second checkwrite to coincide with the receipt of CCNC/CA management fees.
The AMH Medicaid Direct/Managed Care PCP Enrollee Report contains a list of all NC Medicaid beneficiaries who have been assigned to the identified NPI in the past 12 months and contains:
To effectively use the report, add filters or sort the report based on an Active status of “Y.” In this way, the provider can narrow the results to display only those currently enrolled in NC Medicaid and assigned to the identified NPI.
In addition to the Active status, the End Date of assignment will display the current eligibility span for the beneficiary which includes the provider assignment.
It is imperative to understand that this is not verification of eligibility or PCP assignment through that End Date.
NC Medicaid beneficiary benefits or PCP assignment may terminate at the end of any given month. Providers must verify eligibility through the NCTracks Recipient Eligibility Verification function each month to ensure coverage and inform the beneficiary of any changing prior to rendering services.
The most unique feature of the AMH Medicaid Direct/Managed Care PCP Enrollee Report is the identification of the most recent office visit and total number of office visits paid to the identified NPI. This information is offered on the report so providers may confirm whether an active relationship exists with the beneficiary. The dates and number of visits is based on paid claims when the identified NPI in the report is used as the Billing NPI on a paid claim within the past 12 months.
Primary Care Providers (PCPs) actively caring for beneficiaries not showing as assigned to their practice may help update their practice assignment by encouraging beneficiaries to contact their local Department of Social Services (DSS) caseworker to request reassignment. As an alternative, provider staff may complete the Community Care of North Carolina/Carolina ACCESS Enrollment Form for Medicaid Recipient, ask the beneficiary to confirm the change with their signature on the form and fax the form to the local DSS office. Fax numbers and other contact information are available on the Local DSS Directory.
Only the beneficiary may request PCP reassignment. In instances where issues persist or escalation is needed, providers may encourage beneficiaries to contact the Medicaid Contact Center at 888-245-0179 for assistance.
Based on feedback from providers regarding the AMH Medicaid Direct/Managed Care PCP Enrollee Report, and to better assist providers, NC Medicaid is in process of updating functionality to include health plan members and the name of the health plan to which each is assigned. Although the timeline for the addition is yet to be determined, the report will display the health plan name beginning in July 2021 when managed care assignments become effective.
Contact
NCTracks Call Center: 800-688-6696
Read More
The report, initially made available on March 15, 2021, is delivered each month to the NCTracks Secure Provider Portal Message Inbox the Monday before the second checkwrite to coincide with the receipt of CCNC/CA management fees. The AMH Medicaid Direct/Managed Care PCP Enrollee Report contains a list of all NC Medicaid beneficiaries who have been assigned to the identified NPI in the past 12 months and contains:
- NPI/Atypical ID
- Provider name
- Service location address (to which the beneficiary is assigned)
- Medicaid Identification Number
- Recipient name
- Date of birth
- Active (Y or N) (currently enrolled in Medicaid and assigned to you)
- Assignment program (i.e. Med-Dir for NC Medicaid Direct)
- Effective date (of assignment)
- End date (of assignment)
- Last office visit (based on paid claims from the billing NPI)
- Total visits (based on paid claims for the past 12 months)
To effectively use the report, add filters or sort the report based on an Active status of “Y.” In this way, the provider can narrow the results to display only those currently enrolled in NC Medicaid and assigned to the identified NPI.
In addition to the Active status, the End Date of assignment will display the current eligibility span for the beneficiary which includes the provider assignment.
It is imperative to understand that this is not verification of eligibility or PCP assignment through that End Date.
NC Medicaid beneficiary benefits or PCP assignment may terminate at the end of any given month. Providers must verify eligibility through the NCTracks Recipient Eligibility Verification function each month to ensure coverage and inform the beneficiary of any changing prior to rendering services.
The most unique feature of the AMH Medicaid Direct/Managed Care PCP Enrollee Report is the identification of the most recent office visit and total number of office visits paid to the identified NPI. This information is offered on the report so providers may confirm whether an active relationship exists with the beneficiary. The dates and number of visits is based on paid claims when the identified NPI in the report is used as the Billing NPI on a paid claim within the past 12 months.
Primary Care Providers (PCPs) actively caring for beneficiaries not showing as assigned to their practice may help update their practice assignment by encouraging beneficiaries to contact their local Department of Social Services (DSS) caseworker to request reassignment. As an alternative, provider staff may complete the Community Care of North Carolina/Carolina ACCESS Enrollment Form for Medicaid Recipient, ask the beneficiary to confirm the change with their signature on the form and fax the form to the local DSS office. Fax numbers and other contact information are available on the Local DSS Directory.
Only the beneficiary may request PCP reassignment. In instances where issues persist or escalation is needed, providers may encourage beneficiaries to contact the Medicaid Contact Center at 888-245-0179 for assistance.
Based on feedback from providers regarding the AMH Medicaid Direct/Managed Care PCP Enrollee Report, and to better assist providers, NC Medicaid is in process of updating functionality to include health plan members and the name of the health plan to which each is assigned. Although the timeline for the addition is yet to be determined, the report will display the health plan name beginning in July 2021 when managed care assignments become effective.
Contact
NCTracks Call Center: 800-688-6696
As a reminder, once an AMH Tier 3 practice has attested to meeting Glidepath payment eligibility in NCTracks, DHHS will validate that the practice is enrolled with NC Medicaid and attested as an AMH Tier 3 practice. DHHS then confirms the attestation with the respective pre-paid health plans in order to validate that each Tier 3 practice has met contracting and testing criteria.
