Update on ACA Enhanced Rate Payments for Primary Care

The Affordable Care Act (ACA) requires that the Medicaid program pay at the Medicare rate for certain primary care services and to reimburse 100 percent Medicare Cost Share for services paid in calendar years 2013 and 2014. Providers who wish to receive the enhanced rate must attest to their qualifications on the Attestation web portal.

In September 2013, NCTracks began making the ACA enhanced rate payments to providers who attested and were certified by the state for qualified services billed from that point forward.

Currently NCTracks is being updated to include Health Check services (those billed with an EP modifier) among those that are eligible for the incentive, as well as adjustments to the provider Remittance Advice. Once the changes are complete, retroactive reimbursement for claims submitted from July 1, 2013 through present is scheduled to occur in the March 18, 2014 checkwrite. The retroactive ACA enhanced rate payments will be reported in a separate section of the Remittance Advice (RA) to make it easier to identify the payments and post to provider accounting systems. After the reprocessing of claims back to July 1, 2013, NCTracks will begin reprocessing those claims previously processed by HPES for dates of service between January 1 and June 30, 2013. No action is required on the part of certified providers to receive retroactive reimbursement.

Note that the ACA enhanced rate payments are not eligible for primary care services provided to SCHIP/Health Choice recipients. A system change was implemented to eliminate future ACA enhanced rate payments for SCHIP/Health Choice recipients. Prior ACA enhanced rate payments already made to providers for SCHIP/Health Choice recipients will be recouped during the same reprocessing of claims mentioned above.

For more information about enhanced payments under the Affordable Care Act, including qualifications for reimbursement and a link to the attestation process, see Affordable Care Act information on the DMA website and the February 2013 Medicaid Bulletin.


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