Blog Entry List

Effective with date of service Jan. 1, 2021, the Centers for Medicare & Medicaid Services has identified new CPT and HCPCS codes as separately reimbursable in the ambulatory surgery setting.

Providers have until April 30, 2021, to submit a complete and accurate attestation for Program Year 2020. After that no changes can be made.

In addition to the NC Medicaid Provider webpage, Medicaid and NC Health Choice providers now have a supplemental resource to research their questions and submit inquiries.

NC Medicaid has released the NC Department of Health and Human Services Transition of Care Policy, which outlines NC Medicaid's vision on the process of assisting a beneficiary through the transition between health plans or between service/payment delivery systems.

The Department released the Advanced Medical Home Provider Manual 2.0 today. This version reflects program expectations as well as recent program modifications and changes that impact provider contracts.

CPT Code 87428 (related to COVID-19) was improperly defined in a previous Bulletin and is being correctly defined here. 

Effective June 1, 2020, NC Medicaid began reimbursing COVID-19 testing for “Be Smart” Family Planning (MAFDN) beneficiaries through the NC Medicaid Optional COVID-19 Testing (MCV) Program. NC Medicaid is adding codes into NC Tracks for lab testing coverage for MAFDN beneficiaries with retroactive effective dates. 

NC Medicaid is initiating its final phase of reconciling projected versus actual testing cost submission activity for nursing home staff testing payments authorized under Secretarial Orders 2 and 4 on March 1, 2021. 

To continue supporting providers interested in obtaining certification as an Advanced Medical Home Plus (AMH+) practice or Care Management Agency (CMA), the Round 1 application deadline is being extended from March 1, 2021 to June 1, 2021.

This bulletin informs LME-MCOs and providers about the amendments made to providers types eligible to bill the Screening, Brief Intervention and Referral to Treatment (SBIRT) CPT codes effective as of March 1, 2021.

The latest information providers need to know about the transition to Medicaid Managed Care. Update includes the Provider Directory and Health Plan Look-Up Tool, contracting reminders, Provider Playbook updates, upcoming webinars and more.

The Centers for Medicare & Medicaid Services and the American Medical Association have announced the release of several new codes to report testing for COVID-19. 

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.

The U.S. Food and Drug Administration has issued an Emergency Use Authorization to permit the emergency use of the unapproved monoclonal antibodies to be administered for the treatment of mild to moderate COVID-19 in some patients. 

Additional criteria has been added to identify beneficiaries as eligible for Behavioral Health I/DD Tailored Plans.