Topics Related to Bulletins
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations. All eligible professionals (EPs) attesting in Program Year 2019 will be required to attest to Stage 3 MU and use a 2015 Edition of certified EHR technology (CEHRT).
The North Carolina Division of Health Benefits (DHB) would like to reiterate the 340B provider and claim submission requirements for both the outpatient pharmacy and Physician’s Drug Program (PDP).
Supporting beneficiaries in their transition between the current fee-for-service delivery system and NC Medicaid Managed Care is called transition of care. The transitional period surrounding the launch of Medicaid Managed Care is referenced as crossover.
The Department of Health and Human Services (DHHS) recently launched an online “Provider Playbook” as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.
To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the Provider Data Contractor (PDC) will supplement the state’s existing provider credentialing data to the Prepaid Health Plans (PHPs). This will support the PHP’s ability to make quality determinations during Medicaid Managed Care provider network contracting activities. The PHPs will make their quality determination policy public once approved by NC Medicaid.
NC Medicaid has received approval from the Centers for Medicare and Medicaid Services (CMS) to increase rates for Evaluation and Management (E&M) procedure codes, as defined in Section 1202 of the Affordable Care Act (ACA) and paid to primary care physicians, nurse practitioners and physician assistants. In addition to the ACA primary care practitioners, obstetricians and gynecologists will also be included as primary care physicians.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.
The Division of Health Benefits (NC Medicaid) has received approval from the Centers for Medicare & Medicaid Services (CMS) to increase the rate for code T2003 Non-Emergency Transportation, Encounter/Trip for Ambulance Non-Emergency Medical Transportation (NEMT) Services.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.