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  Practice Support Newsletter
  July 2025

Maternal Health Highlights

Coding Corner:
0500F Codes for Medicaid Patients

Effective July 1, 2025, practices providing prenatal and postpartum care to Medicaid patients will receive claim denials if code 0500F is not present in the patient's claim history. Historically, Medicaid has underperformed relative to the national average for the HEDIS Prenatal and Postpartum Care (PPC) measure. One contributing factor may be the delayed billing of codes, up to 84 days post-pregnancy, which often resulted in inadequate capture of this measure from claims and encounter data.

To enhance data collection, Medicaid revised the Obstetrical Services
Clinical Coverage policy, 1E-5. Two new F codes were introduced to better capture prenatal and postpartum care. Code 0500F should be reported during the first prenatal encounter, while code 0503F should be reported to identify the postpartum visit.  If you have questions about the use of these two new codes, check the Prenatal and Postpartum Care F Code Requirement: Frequently Asked Questions.
    
Measure of the Month:
Prenatal and Postpartum Care (PPC)
The Prenatal and Postpartum Care (PPC) measure assesses the quality and timeliness of care provided to pregnant and postpartum women. Specifically, the measure evaluates if these women receive timely and appropriate care which is crucial for positive maternal and infant health outcomes. National Committee for Quality Assurance (NCQA) shares why it matters. NC AHEC also offers a downloadable tip sheet for improving timeliness and access for PPC.

It is a priority measure for
NC Medicaid and PHPs and is part of the Advance Medical Home (AMH) quality measure set.

 
Measure Overview:
The % of live birth deliveries on or between October 8th of the year prior to the Measurement Year and October 7th of the Measurement Year.
For MY25, these dates include women who had a live birth(s): 10/08/2024 – 10/07/2025
 
The PPC measure assesses the following 2 subcategories:
  • Timeliness of Prenatal Care:
    The % of deliveries that received a prenatal care visit in the 1st trimester*, on or before the enrollment date, or within 42 days of enrollment in the organization.
  • Postpartum Care:
    The % of deliveries that had a postpartum visit between 7 and 84 days after delivery.
*The 1st trimester is defined as 280-176 days prior to delivery (or EDD).

Provider Types:
  • OB/GYN and Other Prenatal Care Practitioners
  • PCPs (Includes NP, PA, and CNMs)
Best Practices:
  • Educate members on the importance of receiving timely prenatal care. 
  • Review the prenatal visit schedule at each visit and discuss the importance of follow-up care.
  • Develop internal workflows for rescheduling no-shows and cancellations.  
  • Provide appointment reminders via phone call, email, or text alerts. 
  • Following delivery, schedule postpartum appointments prior to hospital discharge. 
  • Offer extended practice hours to increase access to care.
A few Reminders:
  • PCP visits can close member gaps (For a visit to PCP, the diagnosis of pregnancy must be present).
  • Use appropriate coding on claims.
    • Coding claims correctly closes member gaps and improves data quality reporting
See the coding section for more tips!
 

Spread the Word: For Some Pregnant Moms A Daily Low Dose Aspirin Can Be Life Saving

The American College of Obstetricians and Gynecologists recommends low dose aspirin prophylaxis for pregnant women who may be at risk for preeclampsia. As a leading cause of all maternal mortality, it is the top cause of maternal death among black women. For women with a high risk of preeclampsia low dose aspirin should be initiated between 12 and 28 weeks and continued until the baby is born. If a patient has more than one moderate risk factor aspirin therapy should be considered. Among some of the high risk factors a previous history of preeclampsia, hypertension, diabetes, and autoimmune disease. To review all of the risk factors: Low-Dose Aspirin Use During Pregnancy | ACOG . 

Getting the word out about taking low dose aspirin has been a challenge. Many women remain unaware of their potential risk. The March of Dimes campaign "Low Dose, Big Benefits" aims to increase awareness among both healthcare providers and pregnant women regarding the benefits of low-dose aspirin for those at risk of preeclampsia. Further information and resources for pregnant women and healthcare professionals can be accessed on the March of Dimes
website.

Vaccine Recommendations
Before, During and After Pregnancy

The North Carolina Medical Society highlights that “NCDHHS / Division of Public Health has produced an infographic “Every Mother, Every Baby, Every Time,” which presents conversation tips and vaccine recommendations for providers caring for pregnant persons. Immunizations can help protect women and their babies against diseases including flu, COVID-19, RSV, and pertussis. Making strong vaccine recommendations, especially during respiratory season and while the state is experiencing an increase in pertussis cases, is an important way providers can help prevent disease.

View the most recent
CDC vaccine recommendations for those who are expecting, pregnant or post-partum.

Regulatory Reminders
Medication and Vaccine Cold Chain

“Proper vaccine storage and handling play critical roles in efforts to prevent vaccine-preventable diseases. Vaccines exposed to storage temperatures outside the recommended ranges may have reduced potency, creating limited protection and resulting in the revaccination of patients and thousands of dollars in wasted vaccine.

Proper storage and handling begin with an effective vaccine cold chain.

A cold chain is a temperature-controlled supply chain that includes all vaccine-related equipment and procedures. The cold chain begins with the cold storage unit at the manufacturing plant, extends to the transport and delivery of the vaccine and correct storage at the provider facility, and ends with administration of the vaccine to the patient.

Vaccines must be stored properly from the time they are manufactured until they are administered. Potency is reduced every time a vaccine is exposed to an improper condition. This includes overexposure to heat, cold, or light at any step in the cold chain. Once lost, potency cannot be restored. Exposure to any inappropriate conditions can affect potency of any refrigerated vaccine, but a single exposure to freezing temperatures (0° C [32° F] or colder) can actually destroy potency. Liquid vaccines containing an adjuvant can permanently lose potency when exposed to freezing temperatures” CDC Storage and Handling Toolkit.

The
CDC has an updated toolkit to help your practice ensure vaccines are handled and stored correctly. South Piedmont AHEC encourages your practice to review your current process; if you would like additional support, please reach out to your South Piedmont AHEC Coach.
 

NCDHHS is Accepting Naloxone Provider Requests

In response to the continuing opioid crisis, the North Carolina Department of Health and Human Services (DHHS) seeks to make naloxone, an overdose reversal medication, more widely available, particularly to individuals at highest risk of opioid overdose. 
 
Providers are invited to submit a request via the online survey form: Naloxone Request Survey through Thursday, July 10, 2025. This form is for organizations to submit requests for naloxone for distribution in communities with high overdose rates. This form is not intended for individuals requesting naloxone. For resources related to overdose prevention and accessing naloxone, please visit NaloxoneSaves-nc.org.
 

Tobacco-Related Policy Requirements
Delayed until January 2027

Tobacco-related policy requirements will be effective starting on January 1, 2027. 

To support the health and wellbeing of NC Medicaid beneficiaries and state-funded service recipients, providers are encouraged to begin preparing now to implement tobacco-free policies in advance of the January 1, 2027, deadline. Providers should note that implementation can take three to six months or longer depending on the organization’s current tobacco use policy and treatment supports; many providers have already successfully made this transition.

Read the full announcement from NC DHHS for additional details.
 
AHEC Class Spotlight

Storytelling for Leaders:
Crafting Compelling Narratives that Drive Change

Join South Piedmont AHEC for our Leadership at Lunch Series—a collection of affordable, one-hour trainings designed to help you lead with confidence, resilience, and impact.

Great leaders don’t just share data—they tell stories that move people. In this session, discover why storytelling is essential to your leadership brand, learn the key elements of a powerful narrative, and craft your own story to inspire, connect, and drive change within your organization.

This lunch and learn will be held July 22nd at 12:00pm. To register for this event, visit the South Piedmont AHEC
registration page.

Additional Resources

Medicaid Manage Care
Latest Course Catalog
Collaborative Care Model
Prior Newsletters
South Piedmont AHEC Practice Support
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