SPECIAL BULLETIN COVID-19 #137: Reimbursement for COVID-19 Related Primary Care Services for Uninsured NC Residents – Steps to Prepare

North Carolina Department of Health and Human Services (DHHS) developed a program to reimburse primary care providers (PCP) with federal funds for providing medical care for COVID-19 related services (e.g. follow-up care) to uninsured North Carolina residents. While the portal to submit claims will not be live until late October, claims will be reimbursed retroactively to Sept. 1, 2020. It is important to understand the program qualifications and steps you can take now to prepare. 

Key Program Facts: 

• $7.8M is available to support the program through Dec. 30, 2020, or until the funds are depleted, whichever occurs first. 
• A payment of $150 per eligible encounter enables providers to recoup costs for COVID-19 related services provided for uninsured patients. 
• This new program follows the launch of the Optional COVID-19 Testing Program, which provides reimbursement for testing costs for uninsured and qualified NC residents.

Eligibility

Individuals are eligible for the program if they are North Carolina residents and have no health care coverage (e.g. Medicaid, Medicare, or other health insurance). Eligible providers are PCPs that operate in the state of North Carolina and are registered in NCTracks, North Carolina’s Medicaid payment platform. 

NCTracks Attestation Form includes the following language: By submitting this transaction to the NC Department of Health and Human Services, I attest that the service performed is accurately represented as shown, and the patient was uninsured, and the service was a COVID-19 related primary care service. I further attest that claims have been either submitted to the HRSA portal and denied or were not submitted because they were ineligible for HRSA reimbursement. I understand this transaction is a request for payment from CARES Act funding and is subject to audit by the Office of the State Auditor and other oversight organizations.

Action Items for Providers:

1. Confirm enrollment as a provider in NCTracks. If the provider is not enrolled, they should complete enrollment through the NCTracks portal.
2. Ensure patient does not have medical insurance.
3. Continue providing COVID-19 related care to patients. Hold all eligible encounter information (no earlier than Sept. 1, 2020) until the portal is live. 
4. Submit all qualifying claims and continue to submit regular claims as frequently as possible once the portal is open.

Funding is first-come, first-served until exhausted, or on Dec. 30, 2020, whichever comes first. PCPs will be reimbursed in subsequent NCTracks checkwrites issued by the Division of Health Benefits.

More Information

For more information, review the fact sheet. Stay tuned for additional communications regarding the uninsured portal and training opportunities.