Blue Cross NC Implementing Special Provider Incentive Program for Dual Eligible Special Needs (D-SNP)

At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we appreciate all that you are doing to care for the health and well-being of our members.  

As part of our focus on value and quality in provision of health care to North Carolinians, Blue Cross NC is implementing a special provider incentive program, focused on closing care gaps for our Dual Eligible Special Needs (D-SNP) members for 2023. 

There are two different components of this effort to maximize the quality of care for our 2023 D-SNP members: 

• Provider Care Gap Incentive - $100 per closed gap for the following HEDIS measures: 
  • BCS, Breast Cancer Screening 
  • CBP, Controlling High Blood Pressure 
  • EED, Diabetes: Eye Exam 
  • HBD, Diabetes: HbA1c Control <=9% 
  • COA, Medication Review 
  • COA, Pain Assessment 
  • COL, Colorectal Cancer Screening 
  • FMC, F/U After ED Visit - People with Multiple High-Risk CC 
  • OMW, Osteoporosis Management 
  • SPC, Total Statin Therapy 
  • TRC, Medication Reconciliation Post-Discharge 
• Provider Annual Planned Visit Incentive - $200 per closed gap for APV’s 
  • APV, Annual Planned Visit 

The HEDIS Pocket Guide (PDF) can assist you with code requirements for the various HEDIS measures. See the fact sheet for billing codes related to APV below. 

Blue Cross NC will send incentive payments in Spring 2024 to providers who close the above listed care gaps via administrative claims with dates of service between September 1, 2023 and December 31, 2023. 

If you have questions, please contact Blue Cross NC by sending an email to Quality.Management@bcbsnc.com. 

Thank you for being a valued partner of Blue Cross NC. 

Codes Associated with Preventive Medicine Services 

99391 through 99397 

G0402 – Welcome to Medicare Exam - Physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment. 

The Welcome to Medicare Exam can only be performed ONCE per lifetime. This is different from the Annual Exam codes. 

G0438 – Initial Annual Exam - Visit - Includes a personalized prevention plan of service (PPS), initial visit. 

The Initial Annual Exam can only be performed ONCE per lifetime. This code is different from the Welcome to Medicare exam. 

G0439 – Annual Exam - Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit.