Blog Entry List
Effective April 1, 2020, in response to the anticipated spread of coronavirus (COVID-19) in North Carolina, NC Medicaid is adding "U07.1 - 2019-nCoV Acute Respiratory Disease" as a billable diagnosis. Additionally, diagnosis code U07.1 is being added to the list of diagnoses exempt from the annual visit limit also effective April 1.
Note: Additional Family Planning guidance may be released in the future, which would replace this bulletin.
NC Medicaid has implemented flexibilities on how Medicaid providers deliver and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver.
NC Medicaid has added coverage for providers to help their patients engage in Remote Physiologic Monitoring (RPM), providing the opportunity to improve management of diseases and engage patients in their own care.
This SPECIAL BULLETIN COVID-19 #49 replaces SPECIAL BULLETIN #42: Telehealth Clinical Policy Modifications - Postpartum Care. Please note billing guidance change to postpartum care visits, which can be billed separately OR as part of a pregnancy package code.
The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website: 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA) – March 1, 2020
Given the presence of the COVID-19 virus in North Carolina, point of sale pharmacy claims processing flexibility has been instituted to help reduce the administrative burden of providing appropriate medications in a timely fashion to NC Medicaid and NC Health Choice beneficiaries.
SPECIAL BULLETIN COVID-19 #42: Telehealth Clinical Policy Modifications – Postpartum Care.has been replaced by SPECIAL BULLETIN COVID-19 #49: Telehealth Clinical Policy Modifications – Interim Perinatal Care Guidance.
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid beneficiaries. These changes are retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.
DHHS and Community Care of North Carolina (CCNC) have launched a toll-free Patient Information and Support Line aimed at helping health care providers answer their patients' questions related to COVID-19. Their goal is to relieve some of the tremendous strain the pandemic is putting on health care providers and their staff.
The new helpline is called COVID-19 Triage Plus. Health care providers can recommend their patients call 1-877-490-6642 for assistance from nurse care managers who can help patients with:
Current Policy: Private Duty Nursing (PDN) Clinical Coverage Policy 3G-1. Private Duty Nursing for Beneficiaries Age 21 and older and Private Duty Nursing (PDN) Clinical Coverage Policy 3G-2 Private Duty Nursing for Beneficiaries Age Under 21 years of age section 5.2.4.1:
(d) If services are terminated as a result of the beneficiary’s loss of Medicaid, or if no PDN services are provided during the 30 consecutive days for any reason such as a hospitalization, then the prior approval process must be initiated once again as outlined in Subsections 5.1 and 5.2.
Note: SPECIAL BULLETIN COVID-19 #39 replaces SPECIAL BULLETIN COVID-19 #8: Face-to-Face Provider Site Visits and Fingerprinting Requirements Temporarily Suspended Due to COVID-19 Outbreak. Changes to the prior Bulletin are:
NC-MIPS is Open for Program Year 2019 through April 30, 2020, The Security Risk Analysis, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders
SPECIAL BULLETIN COVID-19 #34 replaces the following Medicaid Bulletins in their entirety: SPECIAL BULLETIN COVID-19 #9: Telehealth Provisions – Clinical Policy Modification; SPECIAL BULLETIN COVID-19 #19: Telehealth Provisions – Clinical Policy Modification and SPECIAL BULLETIN COVID-19 #28: [ADDENDUM to Bulletin #9 Effective March 20, 2020] : Telehealth Provisions – Clinical Policy Modification. New telehealth codes, F. Place of Service change and a clarification to "psychologists" are included.
SPECIAL BULLETIN COVID-19 #35 replaces in its entirety SPECIAL BULLETIN #20 – Enhanced Behavioral Services.