Topics Related to Bulletins
NC-MIPS is accepting Program Year 2018 Modified Stage 2 and Stage 3 MU attestations.
Effective with date of service May 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs covers fosnetupitant and palonosetron for injection, for intravenous use (Akynzeo) for use in the Physician’s Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
Effective July 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs will cover nusinersen injection, for intrathecal use (Spinraza) for use only in the Physician's Drug Program.
Effective with date of service March 8, 2018, the North Carolina Medicaid and N.C. Health Choice (NCHC) programs cover mometasone furoate sinus implant (Sinuva) for use in the Physician's Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs. One Sinuva Sinus Implant system contains 1350 mcg of mometasone furoate and a sterile delivery system.
Effective with date of service April 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs cover fibrinogen concentrate (human) lyophilized powder for reconstitution (Fibryga) for use in the Physician’s Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
If a provider’s enrollment application or Manage Change Request does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.
Note: This article was originally published as a Special Bulletin in January 2018, with updates regarding clinical pharmacist practitioners.
New codes and taxonomies have been added to the procedure code list for Nurse Practitioners and Physician Assistants.
The following new or amended combined North Carolina and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
North Carolina Medicaid will reprocess Medicare Part B Crossover Professional and Outpatient claims submitted to Medicare from Jan. 2, 2017, to Jan. 5, 2017.
Medicare experienced a claims processing issue with claims submitted Jan. 2, 2017 to Jan. 5, 2017, causing incorrect reimbursement. Medicare performed a mass adjustment to correct the reimbursement of the affected claims. However, when the Medicare adjusted claims crossed over to Medicaid, NCTracks denied them in error. The system error that caused the denial of these Medicare adjusted claims has been resolved.
Medicare experienced a claims processing issue with claims submitted Jan. 2, 2017 to Jan. 5, 2017, causing incorrect reimbursement. Medicare performed a mass adjustment to correct the reimbursement of the affected claims. However, when the Medicare adjusted claims crossed over to Medicaid, NCTracks denied them in error. The system error that caused the denial of these Medicare adjusted claims has been resolved.