Practice Support Update Blog

From Data to Impact: How NC HealthConnex Supports NC Medicaid and Providers

Aug 6, 2025 9:45:00 AM / by Practice Support Team posted in NC Healthconnex, Medicaid, Medicaid Managed Care, nchiea

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NC AHEC and DHS Logos_WHITE on BLUE-01Date: August 26, 2025

Time: 12:00 - 1 p.m.

The Statewide Health Information Exchange Act was passed in 2015 by the North Carolina General Assembly.  This legislation paved the way for a statewide health information exchange (HIE), now known as NC HealthConnex.

NC HealthConnex is a valuable tool to support care improvement efforts.  In the context of value-based care, providers need access to timely, accurate clinical data to track outcomes and coordinate care effectively.  By its very definition, value-based care requires visibility into a patient's full journey across the care continuum.

Real-time, reliable clinical data is a critical tool for delivering appropriate care and closing information gaps. NC HealthConnex supports this by offering services that allow providers to:

• Query patients,

• Receive Admission, Discharge and Transfer notifications, and

• Send encrypted messages to other providers involved in a patient’s care.

NC Medicaid’s transition to NC Medicaid Managed Care, the launch of Tailored Care Management, and Medicaid Expansion make NC HealthConnex services an increasingly valuable follow-up tool for providers. The North Carolina Health Information Exchange Authority (NC HIEA), the state  agency that oversees NC HealthConnex, and NC Medicaid have built a strong partnership, collaborating through NC Medicaid Managed Care launch and the COVID-19 pandemic. Today, they are working together on a series of use cases that leverage NC HealthConnex to support NC Medicaid’s quality and population health goals.

In this session, speakers will explain how NC HealthConnex works, review available services, and provide a live demonstration of the NC HealthConnex Clinical Portal. They will also highlight current innovations stemming from the collaboration between NC Medicaid and the NC HIEA. Attendees will leave with an understanding of how NC HealthConnex and its services can serve as valuable tools to support high-quality, coordinated patient care.

Register for the NC HealthConnex Webinar

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Disaster Preparedness for Members with Chronic Conditions

Jul 30, 2025 11:01:22 AM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, crisis, disaster recovery

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NC AHEC and DHS Logos_WHITE on BLUE-01

MEDICAID MANAGED CARE

Disaster Preparedness for Members with Chronic Conditions

August 19 | NOON - 1 p.m.

Please join us for the last webinar in this series focused on disaster preparedness for members with chronic conditions.  This webinar will cover the following:

  • Long term recovery considerations
  • Behavioral Health impacts
  • Finding resources
  • Crisis Services
  • Hope 4 NC
  • Understanding Resilience
  • Building Resilience

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

Register for the Disaster Preparedness Webinar

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Fifth Annual Virtual Statewide Quality Forum

Jul 22, 2025 10:15:00 AM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, Quality Improvement

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NC AHEC and DHS Logos_WHITE on BLUE-01

Save the Date!

Fifth Annual Virtual Statewide Quality Forum

October 8, 2025 | noon - 1 p.m.

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care standard plans, will host the Fifth Annual Virtual Statewide Quality Forum on October 8 from noon-1 p.m. Topics will include:

  • Simplification Updates
  • Key Developments on NC Division of Health Benefits
  • Key Developments on 2026 Advanced Medical Home Measures and Benchmarking Approach
  • Key Developments on NC HealthConnex Updates
  • Screen Early, Optimize Health: Proven Strategies for Success

The forum is designed to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives. Look for additional details, including how to register, soon.

We hope you can join us!

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NC Medicaid Back Porch Chat

Jul 14, 2025 9:00:00 AM / by Practice Support Team posted in Medicaid Managed Care, Healthy Opportunities

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Medicaid Managed Care Back Porch Chat

Key Updates: Children and Families Specialty Plan (CFSP) Launch, HOP

Thursday, July 31 | noon-1p.m.

Please join this month’s Back Porch Chat on Thursday, July 31 from noon to 1 p.m., hosted by Chameka Jackson, Associate Director of the Children and Families Specialty Plan. This webinar will cover critical information for providers regarding the upcoming launch of the Children and Families Specialty Plan (CFSP). Representatives from Healthy Blue Care Together will also share important details to help ensure readiness for the CFSP launch. There will also be an update regarding the Healthy Opportunities Pilot (HOP), presented by Maria Perez, Associate Director of Healthy Opportunities.

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

 

Register for the Medicad Managed Care Chats

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2025 NC Medicaid Standard Plan Performance Comparison Tool

Jul 8, 2025 12:29:11 PM / by Practice Support Team posted in Medicaid, Medicaid Managed Care

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NC Medicaid published the 2025 NC Medicaid Standard Plan Performance Comparison Tool and accompanying Technical Guide. The new tool allows Medicaid beneficiaries to compare the performance of the five NC Medicaid Standard Plans. 

The tool enables beneficiaries to make informed decisions about which Standard Plan works best for them. It provides easy-to-read comparisons of how the Standard Plans perform across different domains of health care, including: getting care, care experience, experience with providers, reproductive and sexual health, and children’s health. The complementary technical guide provides details on how NC Medicaid conducted the comparison, and where the data came from. 

Here's one excerpt from the tool:

Screenshot 2025-07-02 141900

A Full Star means the health plan performed better than the average of all the Standard Plans

A Half-Filled Star means the health plan performed within the average of all the Standard Plans

An Empty Star means the health plan performed worse than the average of all the Standard Plans

Sources:

NC Medicaid Standard Plan Performance Comparison Tool 2025

NC Medicaid 2025 Standard Plan Performance Comparison Tool Technical Guide

NC Medicaid Quality Management and Improvement webpage

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NC Medicaid Provider Enrollment | Webinar Series: Credentialing Committee Initiative

Jun 10, 2025 1:00:00 PM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, practice management

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nc ahec logo

NEW WEBINAR SERIES

NC Medicaid Provider Enrollment

NCDHHS-DHB Credentialing Committee Initiative Stakeholder Engagement Session#3

Please join NC AHEC and the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB), for the third stakeholder teleconference on June 25 from 2-3 p.m. to continue the discussion of a new initiative led in tandem with General Dynamics Information Technology (GDIT). This initiative will establish a Credentialing Committee aimed at maintaining a high-quality, ethical, and competent provider network to support NC Medicaid beneficiaries.

This third forum will offer stakeholders:

  • A collaborative forum to discuss the committee’s future role in the provider enrollment and credentialing process to determine compliance of regulatory requirements by NC Medicaid provider applicants.
  • A deeper dive into the roles of committee members. 
  • Status of committee bylaws.
  • Review of frequently asked questions and answers pertaining to the development of this project.

These stakeholder engagement sessions will occur monthly, as follows, until the project implementation and are intended to be interactive as the Department values input from partnering stakeholders:

  • June 25, 2025
  • July 30, 2025
  • August 27, 2025
  • September 24, 2025

You are encouraged to submit your related questions and comments for targeted open discussion at the meetings to Medicaid.credcommittee.stakeholders@dhhs.nc.gov. We look forward to connecting with you!

Register for the Credentialing Committee Initiative  Webinar Series

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NC Medicaid: New CPT 2 F Codes have July 1 start date

May 28, 2025 4:30:00 PM / by Practice Support Team posted in Medicaid Managed Care, Primary Care, coding, Pregnancy, OB/GYN, postpartum, prenatal

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MedicaidFrom NC Medicaid:

Practices that provide prenatal and postpartum care should bill the new F codes (0503F and 0500F) for their respective services, in addition to using global billing codes after delivery.

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

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Disaster Preparedness for Members with Chronic Conditions

May 28, 2025 3:30:00 PM / by Practice Support Team posted in Medicaid Managed Care, Webinar, chronic conditions

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nc ahec logo

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!

Register for the Disaster Preparedness Webinar

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Medicaid Managed Care Back Porch Chat

Apr 22, 2025 9:00:00 AM / by Practice Support Team posted in Medicaid Managed Care, Primary Care

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nc ahec logo

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!

 

Register for the Medicaid Managed Care Chats

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Submit your feedback on the AMH Standardized Performance Incentive Program Policy by April 21, 2025

Apr 10, 2025 7:00:00 AM / by Practice Support Team posted in Medicaid Managed Care, advanced medical home

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MedicaidToday 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.

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