Update on Pregnancy Medical Homes

The N.C. Division of Medical Assistance (DMA), working in partnership with Community Care of North Carolina (CCNC) and other community stakeholders including providers, local health departments, and the Division of Public Health, created a program that provides pregnant Medicaid recipients with a pregnancy medical home (PMH). The goal of the program is to improve the quality of prenatal care given to Medicaid recipients and improve birth outcomes.

To date, NCTracks has identified claims from PMH providers by use of the “AF� modifier. Using the “AF� modifier, the NCTracks system supports all three types of Pregnancy Medical Home claims that receive higher reimbursement, including the pregnancy risk screening, delivery, and post partum plan.

Beginning May 3, 2015, the “AF� modifier is longer required for PMH providers to be reimbursed in NCTracks. As of that date, NCTracks will recognize which billing and rendering providers are PMH participants, making the “AF� modifier unnecessary.

To be identified in NCTracks as a PMH participant, the provider must have a current contract in place with the local CCNC network. Contracts can be established or updated by submitting a PMH Change Form, which can be obtained from the local CCNC OB team. CCNC sends updates regarding PMH participation to DMA, which in turn updates the NCTracks system. Both billing and rendering providers must be identified as PMH participants in order for PMH incentives to pay.

There will be a 90 day transition period for this change, during which time the “AF� modifier may still be used. The “AF� modifier will be discontinued on July 31, 2015, after which a provider must have the designation of PMH participant in NCTracks in order to receive the incentive payments or enhanced reimbursement rate.