@pipeworx/nc-medicaid-rates

Connect: https://pipeworx.io/mcp — every tool in the catalog, including @pipeworx/nc-medicaid-rates’s. Install: one-click buttons

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Tools: 2

North Carolina Medicaid FQHC and rural health clinic (RHC) core-service (T1015) encounter rates, per provider: one rate per NPI and location with PPS or cost-based basis and begin and end dates, from the NC Department of Health and Human Services, Division of Health Benefits.

Tools

• nc_core_rates(program?, provider?, npi?, schedule?, effective_on?, include_history?, limit?) — per-provider T1015 per-visit rates. Filter by clinic name fragment or 10-digit NPI. effective_on returns the span in force on a date. An unmatched name returns the nearest provider names and says what the table does not hold.
• nc_rate_periods(program?) — the schedules available (effective date, publication update date, provider counts) and what is not covered.

Auth

Keyless.

Data sources

• North Carolina DHHS, Division of Health Benefits (NC Medicaid), FQHC and RHC core-service rate schedules — the per-provider schedules the Division publishes on its FQHC and RHC fee-schedule pages. Public, no account.

Things worth knowing:

• Rates are per provider, not statewide per code. Each row is one NPI and location with its own T1015 rate and effective span.
• The figures are old. The downloadable schedules are the 2020 (effective 2020-03-31) and 2021 (effective 2021-07-01, updated 2021-10-01) core-service schedules. The Division’s later schedules (PPS and alternative payment model rates from 2023) sit in a separate NC fee-schedule portal that this pack does not read, so a provider’s current rate may differ. Every response carries data_as_of and a stale_note.
• The schedules apply to Medicaid Direct (fee-for-service) claims only; managed-care plans pay rates set with NC Medicaid.
• The 2021 rate column is headed “CORE T1015 - Includes Additional 27% Effective” (cut off in the publication); the 2020 schedule states it does not reflect COVID-19 rate increases. The pack returns the rate and does not interpret the heading.
• Provider names are cut off at about 35 characters in the publication; tax id, NPI and location code are returned as strings. There is no address, city or county column, so a place name matches only when it appears inside a provider’s name.
• The 2021 schedules include earlier spans (back to 2019) for providers whose rate changed; by default only spans open-ended when published are returned, include_history returns all, and effective_on picks the span for a date. One RHC row (a Bladen Healthcare location) has a blank PPS/cost-based basis in the publication and is returned with rate_basis: null.
• Organisations only: the schedules list health centres and clinics. Any row whose name reads as a person is dropped when the data is read and counted in individual_rows_dropped (0 in the current schedules).

Stored data and refresh

The four schedules are small (about 1,000 rows, 240 KB). They are read from the Division by scripts/bake-index.mjs into src/nc-rates-data.ts, registered in workers/gateway/src/pack-baked-indexes.json; the deploy uploads the table to KV and the gateway injects it on the first call into this pack, so nothing is evaluated at module scope. node mcps/nc-medicaid-rates/scripts/bake-index.mjs re-reads the files and rewrites the module in place; it refuses a file that changes layout, shrinks below its floor or carries a non-numeric rate. A newly published schedule is added to the FILES list in that script.

Tools

• nc_core_rates — North Carolina MEDICAID (not Medicare) FQHC and rural health clinic (RHC) T1015 core-service per-visit encounter rates, PER PROVIDER (NPI and location, with PPS or cost-based basis and begin/end dates
• nc_rate_periods — List the NC Medicaid FQHC and RHC core-service rate schedules available (effective dates, publication update date, provider counts) and say what is not covered (rates after 2021).