Blog Entry List
Provider Data Management / Credentialing Verification Organization (PDM/CVO) Solution New Launch Date of 2026.
Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.
Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.
The PDM/CVO solution will consolidate provider data management and coordinate provider enrollment, credentialing, and ongoing data maintenance.
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.
Feedback Requested on Proposed Approach
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
States must revalidate the enrollment of all providers at least every five years to ensure the information on record is accurate and current.
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
Recent State Plan Amendment outlines duties of a responsible third party
New separately reimbursable CPT codes in the ambulatory surgery setting
Revised policy in addition to services outlined in Maternity Coverage and Reimbursement Bulletin posted Oct. 23, 2023.
Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.