Billing Requirements for Medicaid Direct Providers
Topics Related to Medicaid Direct
Look for details on training in June related to these changes.
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
Recent State Plan Amendment outlines duties of a responsible third party
New separately reimbursable CPT codes in the ambulatory surgery setting
Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.
The Centers for Medicare & Medicaid Services has approved State Plan Amendments to revise reimbursement methodology.
Claims that reuse the same visit key for multiple dates of service, MIDs, NPIs or procedure codes will deny.
Effective with date of service Jan. 16, 2024, NC Medicaid covers benzathine benzylpenicillin (Extencilline)