Topics Related to Bulletins
NC Medicaid has been reviewing the Medicaid Durable Medical Equipment rates to comply with the new Centers for Medicare and Medicaid Upper Payment Limit requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.
Effective Jan. 1, 2019, optical services shall be covered for adult Medicaid beneficiaries in accordance with S. L. 2018-97, Part III, Section 11H.13.(c). However, Centers for Medicare and Medicaid Services (CMS) approval of the corresponding State Plan Amendment is pending.
This article talks about the new help desk number for PASRR, the new fax number for PASRR-related documents and uploading PASRR-related documents to NCMUST.
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.
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. If Medicare participation cannot be verified, NCTracks will contact the home-state Medicaid program for verification.
Required Medicare participation based on taxonomy will be verified, and home-state Medicaid participation will not be required.
Required Medicare participation based on taxonomy will be verified, and home-state Medicaid participation will not be required.
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. NC Medicaid appreciates the assistance of the provider workgroups to identify issues and confirm improvements once system enhancements were completed. HMS will also continue its other assigned third-party liability reviews.
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 purpose of this service is to assist primary care providers assessing established patients over the telephone to gather additional information.
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. MFP will continue to transition individuals on Medicaid from skilled level, long-term care facilities back to the community until all populations are folded into Medicaid Managed Care. The new application will be effective for participation requests starting Jan. 1, 2019, and will be available on the MFP website after Dec. 1, 2018.