Blue Cross NC Status Codes Reimbursement Policy Update: Codes 99050 and 99051

Due to recent concerns regarding the bundling of Status “B” codes 99050 (after hours services when office is normally closed) and 99051 (services provided in the office during regularly scheduled evening, weekend, or holiday office hours) as described in the Status Codes Reimbursement Policy, Blue Cross NC has made the business decision to update the Status Codes Reimbursement Policy, effective January 21, 2022.

Blue Cross NC will provide reimbursement for service code 99050 and 99051 for any place of service other than urgent care or emergency department for all specialties.

Claims with dates of service prior to January 21, 2022, that are already pended for post pay review will be processed according to the policy in place on the date services were rendered.

As a reminder, with the start of the new year, be sure to check and monitor medical policy changes for all carriers.

Melissa White & Jacob Rodman
NCMGMA Advocacy Co-Chairs

DHHS Announces Prepaid Health Plan Contracts for Medicaid Managed Care

Today, the North Carolina Department of Health and Human Services (DHHS) announced the selection of Prepaid Health Plans that will participate in Medicaid managed care when the program launches in November 2019. Statewide PHP contracts were awarded to AmeriHealth Caritas North Carolina, Inc.; Blue Cross and Blue Shield of North Carolina; UnitedHealthcare of North Carolina, Inc.; and WellCare of North Carolina, Inc. A regional contract for Regions 3 and 5 was awarded to Carolina Complete Health, Inc. More information is available on the PHP Contract Awards Fact Sheet.

Please note that this procurement is for the Standard Plans, in which 1.6 million Medicaid Managed Care beneficiaries will be enrolled. Tailored Plans, designed for certain populations with more specialized behavioral health needs, will be procured later.

Secretary Cohen will be holding a Stakeholder Call to provide an update on the transformation to Medicaid Managed Care, including the PHP contract awards:

Stakeholder Call: Medicaid Managed Care Update
Wednesday, Feb. 6
10-11 a.m.

To register:

Registration is Required to Participate
We are looking forward to working closely with the selected health plans as Medicaid Managed Care launches in two regions in Nov. 2019, and the following regions in Feb. 2020. A map of Medicaid Managed Care Regions and Rollout Dates is available on the Medicaid Transformation website.

Dave Richard
Deputy Secretary
NC Medicaid
Division of Health Benefits
NC Department of Health and Human Services
Office: 919-855-4101
Mobile: 919-500-1596
1985 Umstead Drive, Kirby Building
2501 Mail Service Center
Raleigh, NC 27699-2501
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Multi-Payer Provider Expo on July 19th

Tuesday, July 19, 2016
8:00 AM – 1:00 PM
Charlotte Marriott South Park
2200 Rexford Rd.
Charlotte, NC 28211

Blue Cross Blue Shield of North Carolina, Humana, MedCost, and United Healthcare have partnered together to offer a FREE event. Don’t miss this opportunity to speak one-on-one with expert representatives from each payer, along with other guest exhibitors. Visit each payer and guest to have your name entered into a door prize drawing. Refreshments provided.

Guest Speaker Susan Richards of Humana will present “Improving Clinical Documentation and Why It Matters.” This course is eligible for 2.0 CEU credits. The session will be offered at two different times: 9:00 AM – 11:00 AM (breakfast provided) and 11:00 AM – 1:00 PM (lunch provided). The exhibit hall will be open from 8:00 AM – 1:00 PM.

For more information and a printable registration form, follow this link. Registration closes Wednesday, July 13th.