DMA Announces Requirement To Direct Enroll PAs and NPs

In its September bulletin to all providers, the Division of Medical Assistance (DMA) announced a new requirement for all physician assistants and nurse practitioners to direct enroll in Medicaid.  It is the North Carolina Medical Society’s understanding that the elimination of “incident to” billing and new fee schedules for these non-physician practitioners will follow on the heels of the enrollment effort. Medicaid’s bulletin states that all PAs must be enrolled by December 31 to continue billing Medicaid for services provided to Medicaid patients. Click here for more details from DMA on physician assistant enrollment, and click here for more on nurse practitioner enrollment.

The NCMS opposes any attempt by the N.C. Department of Health & Human Services to make changes to the Medicaid program that will reduce reimbursement rates available to physicians and physician practices.

Under newly enacted state law, this type of policy or program change requires DMA to first adopt a formal rule before moving forward with implementation.  This has not yet occurred, nor has DMA externally released its proposal.  The NC Academy of Physician Assistants, joining NCMS in opposition to DMA’s actions, has recommended that its members hold their applications until DMA clearly establishes its authority for requiring direct enrollment.

As this issue develops NCMS will continue to provide updates.


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  • Conor

    We can confirm that Medicaid is planning to create separate fee schedules for directly enrolled PAs and NPs at reduced rates. We do not yet know the amount of the reduction.

  • So does that mean they are going to cut ALL medicaid reimbursement to us for PA, NP visits by 15%?