In accordance with the North Carolina Medicaid State Plan, Federally Qualified Health Centers and Rural Health Centers may request a rate adjustment due to change in scope of services.
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Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in North Carolina Medicaid and NC Health Choice programs.
Effective with date of service Oct. 8, 2018, North Carolina Medicaid and NC Health Choice programs cover cemiplimab-rwlc injection, for intravenous use (Libtayo) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
Effective with date of service Oct. 3, 2018, North Carolina Medicaid and NC Health Choice programs cover mogamulizumab-kpkc injection, for intravenous use (Poteligeo), for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
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.
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.