Providers: End of COVID-19 Federal Public Health Emergency (PHE)
The COVID-19 federal Public Health Emergency (PHE) helped providers keep their practices running so they could deliver care to Medicaid beneficiaries. The PHE currently extends through later this year. While we do not know when the PHE will end, NC Medicaid wants to help providers understand any potential impacts and steps they can take to be ready. This page will be updated as additional details are available.
Reinstatement of Provider Requirements
As the federal Public Health Emergency (PHE) comes to an end, providers will begin receiving reverification notices again. These notices will be sent to providers with approaching reverification due dates, as well as those whose reverification was suspended during the PHE. For more information, see Provider Reverification Requirements to be Reinstated.
Billing Requirement Modifications Due to COVID-19 Set to Expire
When the end of the federal PHE approaches, NC Medicaid will be ending the temporary emergency flexibilities implemented in response to the federal government’s declaration of the COVID-19 PHE, including the disposition of three claims processing edits.
Edits 02437 and 02425 – “Service Facility Provider Invalid or Not Active on Dates of Service” and “Service Facility Provider Invalid or Not Active on Dates of Service. QMB Recipient” will change from pay and report to deny, as NPI validation will be required once the expiration date of the federal PHE is announced. These edits were relaxed during the pandemic in order to permit any individual practitioner to deliver services at locations not enrolled in NC Medicaid. Providers are encouraged to ensure service facility providers reported on claims are actively participating with NC Medicaid to avoid a claim denial.
Edit 07025 – “Rendering Provider Not Affiliated with Billing Provider” will change from pay and report to deny, as the requirement for an individual provider to affiliate with a billing organization will also be required once the expiration date of the federal PHE is announced. This edit was relaxed during the pandemic in order to permit any group to bill on behalf of an individual provider delivering services at another location/group practice with which the individual is not affiliated. Providers are encouraged to ensure Individual providers are corrected affiliated to Organizations billing on their behalf to avoid a claim denial.
Impacts to Beneficiaries
NC Medicaid encourages providers to be aware of changes that will impact beneficiaries so they can answer questions and direct them to additional resources. For more information, please visit the Beneficiaries: End of COVID-19 Federal Public Health Emergency (PHE) webpage.
Special COVID-19 Bulletins Related to the End of the PHE
For detailed information about changes related to the end of the PHE, please see the COVID-19 Special Medicaid Bulletins webpage. Related articles begin with SPECIAL BULLETIN COVID-19 #220: Temporary Rate Increases Extended or Replaced - Jan. 21, 2022.
This page was last modified on 08/04/2022