COVID-19 Guidance & Resources for Medicaid Providers

NC Medicaid is working with its federal, state and local partners to ensure Medicaid services continue to be delivered without interruption during the COVID-19 (coronavirus) outbreak. For answers to Medicaid policy-related COVID-19 questions, visit the COVID-19 Knowledge Center or email questions to medicaid.covid19@dhhs.nc.gov. Visit the NCDHHS COVID-19 webpage for the latest information about COVID-19, including testing resources and locations.

The federal COVID-19 Public Health Emergency (PHE) ended, May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) allows all providers for whom reverification was delayed due to the federal PHE a specified period to complete the reverification process.
Reverification is no longer optional now that the PHE has ended. Providers for whom reverification was delayed are being organized into groups to ensure the timely completion of the reverification process.

• The Department reviewed the inventory backlog of provider reverifications that were paused during the PHE. Approximately one-third of participating providers will be impacted over the next six months and will be required to respond to the mandatory reverification process.
• Providers should monitor their secure NCTracks Message Inbox for notifications and the Re-verification section of their NCTracks Status and Management page for the option to reverify.

For help with the reverification process, providers can refer to the Provider Re-credentialing/Re-verification webpage in the NCTracks public facing portal. Providers are also encouraged to review Provider Announcements, User Guides and Frequently Asked Questions.

Billing Requirement Modifications Due to COVID-19 PHE Set to Expire

With the end of the federal COVID-19 PHE, NC Medicaid is ending the temporary emergency flexibilities implemented in response to 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 PHE ends.

These edits were relaxed during the pandemic 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 PHE has ended. This edit was relaxed during the pandemic to permit any provider group to bill on behalf of an individual provider delivering services at another location/group practice with which the individual is not affiliated.

Providers should ensure they are correctly affiliated to organizations billing on their behalf to avoid a claim denial. For more information, please see Billing Requirement Modifications Effective May 12, 2023 | NC Medicaid (ncdhhs.gov)