*NOTE: THE CONTENT OF THIS BULLETIN HAS BEEN UPDATED. REFER TO THE SEPT. 24, 2019 MEDICAID SPECIAL BULLETIN FOR REVISED FLEXIBILITIES.
This Special Bulletin includes several articles regarding Hurricane Dorian.
Topics Related to Bulletins
As of the end of August 2019, several issues have been identified with the search function in the Enrollment Broker Provider Directory, including duplicate results, and difficulty finding doctors based on specific criteria such as gender or name.
The Department of Health and Human Services (DHHS) will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on Feb. 1, 2020.
NC Medicaid will reprocess claims with dates of service between Jan. 1, 2019 and Sept. 3, 2019, paid to primary care physicians, nurse practitioners and physician assistants submitted with E&M codes ranging from 99201 to 99499 and the corresponding taxonomies as defined in Section 1202 of the Affordable Care Act (ACA).
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs). NC Medicaid has provided instructions to NCTracks on updating the claims processing system.
Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.
Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Effective with date of service June 20, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Hematopoietic Stem Cell Transplantation (HSCT) clinical coverage policies have been revised. The revisions, which will become effective Oct. 1, 2019 are outlined below:
Several new or amended clinical coverage policies are available on NC Medicaid’s website.