Reimbursement for CMEs
CMEP Provider Portal – Instructions for Reimbursement
The CMEP Provider Portal enables providers to:
- Securely send CME documentation to CMEP for reimbursement and for review
- Track reimbursement status of cases
- Retrieve Checklist for CME Reporting (DMA-1061) forms for cases that have been approved by CMEP for submission to Medicaid
Click here for instructions on navigating the CMEP Provider Portal
Reimbursement Criteria
NC Division of Social Services (DSS) administers CMEP through a contractual arrangement with the University of North Carolina at Chapel Hill School of Medicine and is funded with a combination of federal and state funds. CMEP determines eligibility for payment of services by DSS and assurance to Medicaid that the service meets reimbursement criteria. Program funds are intended only for diagnosis – treatment is not covered by the program. Fees for diagnostic tests shall be reimbursed at the standard Medicaid rates, regardless of payment source. Additional fees for services are not imposed upon clients eligible for these services and acceptance of a referral from a county child welfare agency or DCDEE constitutes the acceptance of this agreement under State and Department of Human Resources contract policies.
CMEP must receive the following documentation via the CMEP Provider Portal to process claims for reimbursement
- Claim Form (CMS 1500), DSS Only
- CMEP Consent Form (DSS 5143)
- NC CMEP Medical Report
- Checklist for CME Reporting (DMA-1061), Medicaid Only
- Case Conference Report Form (if applicable)
NC Medicaid Managed Care Reimbursements
Rostered CMEP providers can receive reimbursement for office consultation provided during a CME to a patient whose primary insurance is with NC Medicaid Managed Care using CPT code 99499. Providers must submit all required documentation to CMEP, which verifies that components of the service have been met.
Providers should submit the signed DMA 1061 and all claims for reimbursement of services – including those not covered by CPT code 99499 – directly to the Health Plan with whom the patient is enrolled.
- Medicaid and Health Choice Child Medical Evaluation Clinical Coverage Policy No: 1A-5
- Click here for a flow chart outlining the CMEP process for Medicaid/NCHC reimbursement
- Click here for Medicaid Transformation FAQs
CMEP/NC DSS Reimbursements
Medical providers rostered with CMEP can receive reimbursement for services provided to patients without insurance or with private insurance. This includes patients who maintain NC Medicaid Managed Care as a secondary insurance. Fees for diagnostic tests not covered by CPT code 99499 will be reimbursed at the standard Medicaid rates, regardless of payment source.
NC DSS will pay for claims up to 60 days past the date of service.
- Please see CMEP Service Options, Descriptions, Requirements and CPT Code Options for guidance in filing claims for reimbursement by NC DSS.
- Click here for a flow chart outlining the CMEP process for DSS/DCDEE reimbursement
Third Party Claims
It is the provider’s responsibility to ensure that CMEP receives third party claims for diagnostic testing if CMEP is to reimburse for the service. CMEP does not maintain agreements with third party providers. Third party claims should be sent to CMEP via the CMEP Provider Portal.