April Provider Digest
AmeriHealth Caritas North Carolina (ACNC) is committed to providing the support you deserve. A Known System Issues Tracker is updated weekly and also available in NaviNet to providers.
You will find the following topics in this April digest:
QUALITY CORNER
SAVING TIME
CLAIMS AND BILLING
- Personal Care Services (PCS) Billing and Reimbursement Policy Update
- New Webpage for Home Health Care Services (HHCS) With Electronic Visit Verification (EVV) Process
MEMBER SPOTLIGHT
REMINDERS
- FREE CEUs for Online Psychological First Aid Training
- Grant Opportunity for Collaborative Care Management (CoCM)
Learn About Value-Based Care Reimbursement
Providers and administrators are invited to join our physical and behavioral health clinical leaders, Dr. Steve Spalding and Dr. Nerissa Price, on Tuesday, June 3, from noon to 1 p.m., for our 2025 PerformPlus® True Care Programs Overview Webinar. In this first part of our 2025 Clinical Leadership Forums, you will learn about:
- ACNC PerformPlus Portfolio
- Scorecards and dashboards
- Reporting
- Tools and resources
We welcome your questions as we work together to deliver high-quality, cost-effective and timely care to our members.
Share Your Clinical Feedback
As an ACNC network provider, you are encouraged to offer your expertise to evaluate the effectiveness of our Quality Assessment Performance Improvement (QAPI) program and share insights regarding clinical initiatives by participating in virtual committee meetings hosted by ACNC medical leadership.
Providers are compensated for their time and participation. Please see the following for more details, and use this link to email our Quality team if you would like to know more.
We are specifically seeking representation from the following specialty providers:
- Ear, nose and throat specialists
- Endocrinologists
- General surgery practitioners
- Geriatricians
- Women’s health specialists
The Quality Assessment Performance Improvement Committee (QAPIC) meets every other month for two hours and oversees ACNC efforts to measure, manage and improve high-quality member outcomes.
The Provider Clinical Oversight Workgroup (PCOW) meets for one hour each month and is responsible for monitoring ACNC strategies and metrics to provide input and guidance on the health plan’s improvement efforts, including reviewing new/updated clinical policies and providing feedback. This workgroup reports to the QAPIC.
Depression Screening and Follow-Up for Adolescents and Adults (CDF)
Measure Steward: Centers for Medicare & Medicaid Services (CMS)
The Depression Screening and Follow-Up for Adolescents and Adults (CDF) measure encompasses patients 12 years of age and older who have never been diagnosed with depression or bipolar disorder. This measure evaluates the percentage of patients who were screened for depression on the date of the encounter (or up to 14 days prior) using an age-appropriate standardized depression screening tool. If the patient screened positive, a follow-up plan is documented on the date of or up to two days after the encounter.1
Examples of adult and adolescent screening tools2
| Adult and adolescent | Adult (18+) | Adolescent (12 – 17) |
|---|---|---|
| Patient Health Questionnaire (PHQ-9 & PHQ-A) | Quick Inventory of Depressive Symptomatology Self-Report (QID-SR) | Interview Schedule for Children and Adolescents (ISCA) |
| Beck Depression Inventory (BDI or BDI-II) | Computerized Adaptive Diagnostic Screener (CAD-MDD) | |
| Center for Epidemiologic Studies Depression Scale for Children (CES-D & CES-DC) | Depression Scale (DEPS) & Geriatric Depression Scale (GDS) |
CDF coding/documentation3
| Screening is positive | Screening is negative | |
|---|---|---|
| Description | Screening for depression is documented as positive, and a follow-up plan is documented. | Screening for depression is documented as negative. No follow-up plan is required. |
| HCPCS Codes | G8431 | G8510 |
Screening interventions, most of which also included other care management components, were associated with a lower prevalence of depression or clinically important depressive symptomatology.4 Some additional best practices are:
- Complete a screening every year and include appropriate G codes in claims.4
- If screening is positive, make sure there is documented evidence of follow-up care specifically for the screening, such as a referral to a provider for additional evaluation and assessment or pharmacological interventions.1
- Ensure there is documentation of a referral or the need for further evaluation on the encounter date. Referrals can be sent to the following provider types: psychiatrist, psychiatric nurse practitioner, psychologist, clinical social worker, mental health counselor, or other mental health service.
Please contact your Provider Network Management Account Executive with any questions. For providers that would be interested in partnering with ACNC on screening events, please contact ACNC quality management by email at ACNCQualityManagement@amerihealthcaritas.com.
1Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set): Technical Specifications and Resource Manual for 2025 Core Set Reporting,” Center for Medicaid and CHIP Services and Centers for Medicare & Medicaid Services, January 2025, https://web.archive.org
2Kamakshya Patra and Reena Kumar, “Screening for Depression and Suicide in Children,” StatPearls, June 21, 2023, https://web.archive.org/
3“2025 Adult Core Set Non-HEDIS Value Set Directory: 2025-Adult CDF Codes,” Medicaid.gov, https://www.medicaid.gov/medicaid/quality-of-care/downloads/2025-adult-non-hedis-value-set-directory.zip
4“Depression and Suicide Risk in Adults: Screening,” U.S. Preventive Services Task Force, June 20, 2023, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-adults
Processing Prior Authorizations — Tip for Unit Submission
We recognize that valuable treatment time can be lost for our members when providers are saddled with overly restrictive processes. ACNC recently announced removal of more than 240 physical health codes and a dozen behavioral health services codes. If you missed the full announcement, find it on our Newsletters and Updates webpage.
Check out this month’s tip to help decrease administrative burden and save you time.
Tip for Unit Submission
It is necessary to enter all codes and units a member needs during the initial submission (amendment). Double check that the following are complete: relevant diagnosis codes, procedure codes, modifies (modifiers) and units. Without this complete data, prior authorizations are delayed. For durable medical equipment (DME) providers, when submitting an equipment rental, make sure to include the total number of units needed to cover the rental period you are requesting. For example, a continuous positive airway pressure (CPAP) machine rental for a 10-month period will need 10 units to allow for one unit to be billed per month.
Do you want to learn more? Save the date, July 8, 2025 for the Clinical Leadership Forum at noon titled Saving Time with Prior Authorization Submissions.
Personal Care Services (PCS) Billing and Reimbursement Policy Update
As of April 1, 2025, North Carolina Department of Health and Human Services (NCDHHS) released reimbursement methodology changes for providers rendering personal cares services (PCS) in congregate care settings. Procedure code 99509 has been impacted, and new elements of the methodology are indicated in the December 20, 2024, NCDHHS bulletin.
New Webpage for Home Health Care Services (HHCS) With Electronic Visit Verification (EVV) Process
This update is specifically for the home health providers that bill taxonomy code 251E00000X.
Providers are encouraged to review our new Home Health Electronic Visit Verification webpage for more in-depth process instructions. ACNC has a designated team of Provider Network Management Account Executives to support training and billing. Reach out to us anytime, and we look forward to seeing you on an upcoming Wednesday evening.
Offering Members Access to No-Cost Language Interpretation Services
Members should be advised that interpretation services from ACNC are available at no cost. When a member uses ACNC interpretation services, the provider must sign, date, and document the services provided in the medical record in a timely manner.
How to use our interpretation services:
- Inform the member of their right to no-cost interpretation services.
- Make sure a phone is in the room, or use a cell phone.
- Call Member Services at 1-855-375-8811, 24 hours a day, 7 days a week, with the member ID number, and Member Services will connect you to the necessary interpreter.
- Conduct an exam with the interpreter over the phone.
Tips for working with a member using an interpreter5
- Speak directly to the patient, not to the interpreter.
- Do not rush. Pause every sentence or two for interpretation.
- Use plain language. Avoid slang and sayings. Jokes do not always translate well.
- Check for understanding occasionally by asking the patient to repeat back what you said. This is better than asking, “Do you understand?”
In addition, translation services must be provided to ensure adherence to providing services in a culturally competent way. Please review additional details about Culturally Competent Care and Cultural Competency Training on our website.
5Source: Provider Training Resources, Community Health Partnership of Southeastern Michigan. “Culturally Competent Communication Tools and Techniques” 2008, Washtenaw County, MI 23 January 2010.
FREE CEUs for Online Psychological First Aid Training
AmeriHealth Caritas North Carolina is pleased to invite providers to join us for an online course, Psychological First Aid.
Training is designed for providers to help survivors manage emotional distress and cope with post-disaster stress and adversity. This online course is developed by the National Center for PTSD and the National Child Traumatic Stress Network. This five-hour online course offers five continuing education units (CEUs) upon completion.
To register and to find out more, visit our newly designed Provider Training webpage.
Grant Opportunity for Collaborative Care Management (CoCM)6
“The NC General Assembly has allocated $5 million for capacity building of Medicaid-enrolled primary care practices across the state to adopt CoCM.”
“CoCM improves patient outcomes, increases satisfaction for both patients and providers, and reduces healthcare costs and stigma related to mental health and substance use disorders. The model complements other integrated models, including the North Carolina Psychiatric Access Line (NC-PAL).”
“For more information about the CoCM model and training opportunities, explore NC AHEC and the AIMS Center.” Review the CoCM Capacity Building Fund one-sheet (PDF) for support when applying for the grant.
6 “Collaborative Care Management,” NC Medicaid Division of Health Benefits, https://web.archive.org/web/20250325151812/https://medicaid.ncdhhs.gov/providers/programs-and-services/collaborative-care-management