Clinical Coverage Policy 1A-22, Medically Necessary Circumcision, has been revised and will post with an effective date of Jan. 1, 2021 on the NC Medicaid website.
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An amended version of Clinical Coverage Policy 1E-7, Family Planning Services with an effective date of Dec. 1, 2020, was posted to the NC Medicaid Clinical Coverage Policy webpage.
Effective Oct. 1, 2020, NC Medicaid will now cover services for transversus abdominis plane blocks for Medicaid and NC Health Choice beneficiaries 11 years and older.
Program of All-inclusive Care for the Elderly (PACE) organizations should continue to follow the guidance of local, state and federal officials regarding COVID-19 and thoroughly document reasoning for making decisions which may fall outside of the PACE program model.
This bulletin revises the COVID-Response Site criteria established in SPECIAL BULLETIN COVID-19 #82.
Updates on the consent form expiration date and clarifications related to the Aug. 15, 2020 policy update.
Claim Denials for Sterilization CPT Code 58661
As Medicaid and NC Health Choice transition to managed care, beneficiaries will be notified to select a Prepaid Health Plan as well as a Primary Care Provider/Advanced Medical Home. Beneficiaries who do not self-select will be auto assigned by the Department.
Effective July 26, 2020, Registered Dieticians and Nutritionists may enroll in Medicaid or the NC Health Choice program to provide and bill for this service for pregnant women and beneficiaries less than 21 years of age.
Effective with date of service Aug. 4, 2020, the Medicaid and NC Health Choice programs cover amisulpride injection, for intravenous use (Barhemsys®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
The latest version of the Third-Party Liability Medicaid and NC Health Choice billing guide is available.
The Tailored Care Management certification process is now open, and providers may submit applications.
Provider webinars in December include Advanced Medical Home on December 10, COVID-19 Vaccine Distribution on December 15, and Behavioral Health on December 17.
Key dates for transitioning to Medicaid Managed Care, contracting reminders, webinar series for providers and practice leaders, review your provider records in NCTracks, the Provider Ombudsman, PHP manuals updated and the beneficiary portal.
Effective July 1, 2020, End Stage Renal Disease Treatment providers (261QE0700X) were added to the list of eligible providers for Procedure Code J0887, Mircera Injection, Epoetin Beta, 1 Microgram.