NCMS Morning Rounds 7-13-21

Terrific Tuesday! Enjoy your NCMS Morning Rounds.

July 13, 2021

Common Billing Error – Taxonomy Codes Missing, Incorrect or Inactive

This is a reminder to include taxonomy codes when submitting claims to PHPs, either by individual providers or through a trading partner.

Similar to NCTracks, all PHP systems require taxonomy codes to be submitted on all claim types except pharmacy point of sale claims. When submitting claims to these systems, it is important that providers continue to submit the appropriate billing and, when applicable, rendering/attending taxonomy code which is expected to be consistent with the codes on their NCTracks provider record based on the service rendered and the rendering/attending provider location. Both the billing provider and the rendering provider have their own taxonomy codes on the claim.

Providers should verify that the submitted provider taxonomy code on the claim matches one of the active taxonomy codes listed on the NCTracks provider record and is appropriate for the claim being billed. Providers should validate the configuration of their own billing systems to ensure taxonomies are included when submitting claims to the PHPs.

The NCTracks How to view and update Taxonomy on the Provider Profile in NCTracks User Guide provides additional information on how to view and update taxonomy on the provider profile.

Reminder: Health Equity Payment Initiative Survey

All Carolina Access Providers who received health equity payments are asked to take 5-10 minutes to complete this survey by July 16, 2021. The survey allows DHHS to monitor and evaluate how these payments were used.

Practices receiving enhanced payments must complete a practice survey following this health equity initiative; failure to complete the survey may result in NC DHHS recouping payments.

In March of 2021, NC Medicaid announced the health equity payment initiative, providing certain Carolina Access providers serving Medicaid beneficiaries from high poverty areas of the State enhanced payments for a 3-month period to achieve health equity among North Carolina’s Medicaid population.

The initiative aimed to improve access to primary care and preventive services for Medicaid and NC Health Choice beneficiaries in North Carolina at a time when historically marginalized populations face challenges highlighted during the COVID-19 public health emergency.

Medicaid Claim Submission and Prior Authorization Clarifications

To provide some clarity on prior authorization submissions, the NC Department of Health and Human Services (NCDHHS) issued an updated Provider Bulletin last Friday that includes  information about claims submission and prior authorizations under Medicaid managed care. Learn about claims submission and prior authorization here. You can review a breakdown by pre-paid health plan (PHP) in this chart. 

Also, keep in mind if a prior authorization was previously obtained by your practice for Medicaid members prior to Medicaid managed care go-live on July 1, 2021, the prior authorization should have been sent from the state to the PHP(s) you are contracted with and no further action is needed.

Some of the PHPs have received prior authorization requests that were previously submitted and approved by NCDHHS.  Please do NOT submit a prior authorization if one was already approved by the state. If a practice wants to verify if the PHP has a prior authorization, please contact the provider relations team directly at the specific PHP. That contact information for each of the health plans is available on the NCMS Medicaid Transformation webpage here, where you will also find a variety of other helpful resources related to Medicaid managed care.

In the News

How the Pandemic Made Childhood Obesity Worse, According to New Research, Advisory Board, 7-9-21

Learning Opportunity

TOBACCO DEPENDENCE PHARMACOTHERAPY, September 23, 2021, 12:00pm-5:00pm EDT

Medication strategies for tobacco use continue to evolve, with the use of pre-quit treatment, extended treatment, low-dose varenicline, high-dose nicotine, and combination treatment. Most medical providers are unaware of how or when to use these effective approaches.

This training is designed for physicians, physician assistants, nurse practitioners, pharmacists and tobacco treatment specialists who work with smoking cessation medications and would benefit from an understanding of the current research guiding smoking cessation pharmacotherapy. The course will provide an overview of the neurobiology that gives rise to nicotine dependence and how various medications impact that neurobiology. We will provide guidance on treatment that is relevant to most clinicians including:

  • approaches to varenicline use that maximize efficacy and minimize side effects
  • use of combination medication treatment
  • evidence for the use of pre-quit smoking cessation medications
  • use of extended post-quit medications and the use of adaptive treatment

We explore specific cases, such as use of tobacco treatment medications in hospitalized patients, surgical patients, acute cardiac care, renal failure, cancer treatment, e-cigarette use, oral tobacco use, and adolescent treatment, as well as treatment of light-intermittent smokers and high-dependence smokers. The course is designed to provide practical guidance for clinicians and lead to real change in clinical practice.

Learn more and register here.


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