To comply with a final rule issued by the Centers for Medicare and Medicaid Services (CMS), which requires additional disclosures by enrolling providers, revisions to the NC Medicaid Provider Enrollment Application are underway. This final rule, effective Nov. 4, 2019, implements statutory provisions that require providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers.
Blog Entry List
In preparation for the upcoming holidays, please be aware of the change to the schedule for posting of Medicaid Bulletin articles.
New or amended clinical coverage policies are available on NC Medicaid’s website.
NC Medicaid reimburses qualified providers for child medical evaluation and medical team conference services according to guidelines set forth in NC Medicaid policy 1A-5 Child Medical Evaluation and Medical Team Conference for Child Maltreatment.
The NC Medicaid Electronic Health Record Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.
A new or amended clinical coverage policy regarding facility-based crisis management for children and adolescents is available on NC Medicaid’s website.
NC Medicaid has updated its ICD-10 diagnosis code list. Diagnosis code K35.891 (other acute appendicitis without perforation, with gangrene) has been added as an acceptable ICD-10 diagnosis code effective Oct. 1, 2018.
As NC Medicaid's managed care launch date approaches, Advanced Medical Home (AMH) providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2.
The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. (CCH) to serve as a health plan under the state’s transition to Medicaid Managed Care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.
The clinical criteria used by NC Medicaid for the 2019-2020 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31st Edition. This guidance for Synagis use among infants and children at increased risk of hospitalization for RSV infection is available online by subscription. The coverage season is Nov. 1, 2019, through March 31, 2020. Providers are encouraged to review the AAP guidance prior to the start of the RSV season.
Several new or amended clinical coverage policies are available on NC Medicaid’s website.
Providers were notified in the August Medicaid bulletin that as of May 1, 2019, the sterilization consent form was updated with an expiration date of April 30, 2022. The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated. Providers should now be using this version when submitting the sterilization consent form to the NC Medicaid fiscal agent.
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations. All eligible professionals (EPs) attesting in Program Year 2019 will be required to attest to Stage 3 MU and use a 2015 Edition of certified EHR technology (CEHRT).
The 2020 ICD-10 update will be in place effective Oct. 1, 2019 through Sept. 30, 2020, for provider use. Providers can access the list of ICD-10 codes on the Centers for Medicare and Medicaid Services (CMS) website.