Topics Related to Bulletins
North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan. 1, 2020. This will result in higher recoveries for the state and higher pay rates for providers. HMS will assist Medicaid providers by identifying and validating other (non-Medicaid) health coverage so that providers can maximize payment rates by billing commercial rates rather than Medicaid rates.
Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes.
New or amended clinical coverage policies are available on NC Medicaid's website.
The Physicians, Nurse Practitioners and Physician Assistants fee schedules have been revised to include the Evaluation and Management fee schedules.
The NC Medicaid EHR Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.
A Clinical Coverage Policy has been developed to add coverage for Chimeric Antigen Receptor (CAR) T-Cell Therapies KYMRIAH and YESCARTA. This policy will become effective Dec. 1, 2019.
The Centers for Medicare and Medicaid Services (CMS) has recently provided clarification outside of the specification sheet for their intent of Stage 3 Meaningful Use’s Objective 5, Measure 1.
While this year’s legislative session was one of the longest in recent memory, it ended without needed action required for managed care to move forward. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Therefore, the Department of Health and Human Services will be suspending managed care implementation and open enrollment. Managed care will not go live on February 1, 2020.
To comply with a final rule issued by the Centers for Medicare and Medicaid Services (CMS), which requires additional disclosures by enrolling providers, revisions to the NC Medicaid Provider Enrollment Application are underway. This final rule, effective Nov. 4, 2019, implements statutory provisions that require providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers.