NC Core Code Implementation for New 1915(i) and 1915(b)(3) — H2023 Supported Employment Services
Customize your policy alerts
Sign up for all clearhealthalliance policy alerts
Know when clearhealthalliance releases new policies or updates existing guidance.
Monitor payer policy activity
Defines coding/modifier requirements and new NC CORE service designations for H2023 supported employment encounters, including removal of certain Z modifiers and mapping to 1915(i) and 1915(b)(3) milestone codes; affects providers submitting encounters to Clear Health Alliance.
Z modifiers specific to H2023 will no longer be allowed as of 10/1/2024 because they are no longer HIPAA compliant.
New 1915(i) and 1915(b)(3) NC CORE milestone designations (REF*P4*1915I-M# and REF*P4*1915B3-M#) for H2023 to be used effective 10/1/2024 and programmed for contractors by 7/1/2024.
Old U4 and U4+Z modifier combinations are to be end-dated as of 6/30/2024 and are no longer valid as of 10/1/2024.
H2023 Submission and NC CORE Mapping
H2023 submission and NC CORE mapping criteria
Submission requirements and mapping for H2023 supported employment encounters:
NC CORE designation — choose the appropriate REF indicator when applicable
- Use REF*P4*1915I-M# to indicate 1915(i) NC CORE milestone designations M1 through M9 when applicable.
- Use REF*P4*1915B3-M# to indicate 1915(b)(3) NC CORE milestone designations M1 through M9 when applicable.
NC CORE Milestone Mappings and Modifier Cutoffs
| H2023 + REF*P4*1915I-M1 | NC CORE Individual Placement Support Milestone 1 - |
| H2023 + REF*P4*1915I-M2 | NC CORE Individual Placement Support Milestone 2 - Intake/Career Assessment |
| H2023 + REF*P4*1915I-M3 | NC CORE Individual Placement Support Milestone 3 - Job Development |
| H2023 + REF*P4*1915I-M4 | NC CORE Individual Placement Support Milestone 4 - Job Support and Vocational Recovery, EIPD Ineligible |
| H2023 + REF*P4*1915I-M5 | NC CORE Individual Placement Support Milestone 5 - Vocational Rehabilitation Closure, EIPD Ineligible |
| H2023 + REF*P4*1915I-M6 | NC CORE Individual Placement Support Milestone 6 - Long-Term Follow-Along |
| H2023 + REF*P4*1915I-M7 | NC CORE Individual Placement Support Milestone 7 - Vocational Advancement |
| H2023 + REF*P4*1915I-M8 | NC CORE Individual Placement Support Milestone 8 - Educational Attainment |
| H2023 + REF*P4*1915I-M9 | NC CORE Individual Placement Support Milestone 9 - Successful IPS Closure Outcome Payment to Provider |
| H2023 + REF*P4*1915B3-M1 | NC CORE Individual Placement Support Milestone 1 - |
| H2023 + REF*P4*1915B3-M2 | NC CORE Individual Placement Support Milestone 2 - Intake/Career Assessment |
| H2023 + REF*P4*1915B3-M3 | NC CORE Individual Placement Support Milestone 3 - Job Development |
| H2023 + REF*P4*1915B3-M4 | NC CORE Individual Placement Support Milestone 4 - Job Support and Vocational Recovery, EIPD Ineligible |
| H2023 + REF*P4*1915B3-M5 | NC CORE Individual Placement Support Milestone 5 - Vocational Rehabilitation Closure, EIPD Ineligible |
| H2023 + REF*P4*1915B3-M6 | NC CORE Individual Placement Support Milestone 6 - Long-Term Follow-Along |
| H2023 + REF*P4*1915B3-M7 | NC CORE Individual Placement Support Milestone 7 - Vocational Advancement |
| H2023 + REF*P4*1915B3-M8 | NC CORE Individual Placement Support Milestone 8 - Educational Attainment |
| H2023 + REF*P4*1915B3-M9 | NC CORE Individual Placement Support Milestone 9 - Successful IPS Closure Outcome Payment to Provider |
Required Submission Changes and Provider Instructions
Modifier and NC CORE designation submission requirements
Do not submit Z modifiers with H2023 for services on or after 10/1/2024; encounters with H2023 that include Z modifiers for services rendered 10/1/2024 or later will be rejected by the Encounter Processing System with an 'error' type business rule. Instead, when indicating NC CORE milestone designations for 1915(i) or 1915(b)(3) services, submit the REF*P4*1915I-M# or REF*P4*1915B3-M# indicator corresponding to the applicable milestone (M1–M9).
- Old U4 and U4+Z modifier combinations should be end-dated as of 6/30/2024 and are no longer valid as of 10/1/2024.
- New 1915(i) and 1915(b)(3) codes/identifiers will be programmed for Tailored Plan and PIHP contractors by 7/1/2024 and must be used beginning 10/1/2024 for NC CORE designation validation.
System and Identifier Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.