Posted in MVP (NY/VT) Insurance Payer, NY Providers, Payer Updates, Payers and CPT reinbursement

MVP (NY/VT)- Reimbursement sick visit and Preventative Care on the same day.

Effective 5/1/23 MVP insurance payer will start to reimburse 50% for the E&M code that represents the sick visit and is billed on the same day as the preventative E&M code.

The providers should expect this reduction to apply to the code even if the modifier 25 is appended on the sick E&M code.

This update in reimbursement applies to both NY and VT providers.

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Posted in Training, Updates

Humana: change to Nurse Practitioner and PA credentialing requirements.

This post applies to any NP or PA that are seeing Humana patients in the office.

The change is affective as of DOS 08/01/2021 and thereafter and applies to NP and PA no matter if they are part of a physician group and not solely acting as a primary care provider.

Effective 08/01/2021, nurse practitioners and and physician assistants are required to get credentialed with Humana, in order to see Humana members in network.

What you need to do?

Please visit Humana website for helpful guidelines or review Human credentialing policy:

If you need any help with the process or have any questions, please contact the us via email or phone:

Email: – please include your full name, specialty, tax payer identification number (TIN)

Phone: 800-457-4708

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Posted in My services, Training, Updates

NC Primary Care Providers can get paid for COVID-19 testing of Uninsured Patients

On 10/30/2020- NC HHS Department has created an online portal for Primary Providers to submit COVID-19 claims for uninsured patients.

This is a first-come first-serve reimbursement to primary care providers who are providing COVID-19 related primary care services to uninsured individuals living in North Carolina*. Per the federal CARES act.

In order to qualify the provider must be:

  1. Primary Care
  2. Operate in North Carolina
  3. Participate in NC Medicaid Program
  4. Be registered in NCTracks payment portal


Providers must attest to the following at registration:

• Providers have checked for health care coverage eligibility and confirmed that the patient is uninsured. Providers have verified that the patient does not have coverage through an individual, or employer-sponsored plan, a federal health care program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse you for COVID-19 testing and/or care for that patient

* Providers will accept defined program reimbursement as payment in full

• Providers agree not to balance bill the patient

• Providers agree to program terms and conditions and may be subject to post-reimbursement audit review


Providers will receive $150 per eligible visit.

Reimbursement Process:  

1. PCPs should confirm their enrollment as a provider in the NCTracks system. Enrollment can be completed in the portal.

2. PCPs should perform COVID-19 related services (e.g. follow-up care) for patients as usual.

3. PCPs must ensure the patient does not have insurance to be eligible for the program, PCPs should use the NCTracks portal to complete the attestation form to file the claim. Attestation will serve as verification of eligibility.

NCTracks Attestation Form includes the following language:

By submitting this transaction to the NC Department of Health and Human Services, I attest that the service performed is accurately represented as shown, and the patient was uninsured, and the service was a COVID-19 related primary care service. I further attest that claims have been either submitted to the HRSA portal and denied or were not submitted because they were ineligible for HRSA reimbursement. I understand this transaction is a request for payment from CARES Act funding and is subject to audit by the Office of the State Auditor and other oversight organizations.

4. PCPs should regularly file claims in the provider portal. If the claim has been successfully filed in NCTracks and there are still funds available, PCPs will be reimbursed in subsequent NCTracks check writes issued by the Division of Health Benefits.

Official Press Release from NCHHS, please click here!