NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved.
Topics Related to Bulletins
In response to the anticipated higher than normal number of influenza cases this coming season, effective December 1, 2018, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms.
The Money Follows the Person Demonstration Project (MFP) team is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year.
Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.
Medicaid has designated specific ICD-10-CM diagnosis codes that do not count toward the annual visit limitation. These codes are reviewed regularly and updated as appropriate.
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for CPT codes 90791 – Psychiatric Diagnostic Evaluation and 90792 – Psychiatric Diagnostic Evaluation with Medical Servicess when provided via telemedicine/telepsychiatry.
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Nov. 1, 2018.
As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.
The Money Follows the Person Demonstration Project is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year.