This communication serves as an advisory notice for all Providers. The intent is to increase awareness of the Medicare Advantage Plan. The statement below should be used to gain further clarification regarding claims denied for Medicare Part C coverage.
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Health Management System is under contract with North Carolina Medicaid as NC Medicaid’s Recovery Audit II Contractor, pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010.
North Carolina’s Department of Health and Human Services, Division of Health Benefits (DHB) has contracted with Health Management Systems (HMS) to conduct Overpayment Recovery Reviews for Medicaid/Health Choice recipients.
Psychiatric collaborative care management services must be rendered under the direction of a treating physician or non-physician practitioner, typically in a primary care setting. These services are rendered when a beneficiary has a diagnosed psychiatric disorder and requires assessment, care planning and provision of brief interventions.
Bone Mass Measurement policy has been updated to reflect the addition of anorexia nervosa as an approved diagnosis for beneficiaries with other conditions or currently receiving medical therapies known to cause low bone mass.
New or amended clinical coverage policies are available on Telemedicine and Telepsychiatry, Outpatient Specialized Therapies and Bone Mass Measurement
In response to provider requests and to align more closely with Medicare coverage for Independent Diagnostic Testing Facilities (IDTF), effective June 1, 2019, NC Medicaid will add coverage for additional procedure codes outlined in the attached document.
To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the Provider Data Contractor (PDC) will supplement the state’s existing provider credentialing data to the Prepaid Health Plans (PHPs). This will support the PHP’s ability to make quality determinations during Medicaid Managed Care provider network contracting activities. The PHPs will make their quality determination policy public once approved by NC Medicaid.
The Department recognizes that the move to managed care may impose additional administrative burdens and program complexity to the work NC providers already do. To mitigate the administrative burden on providers as NC Medicaid transitions to managed care, the Department procured a contractor to supplement the state’s existing provider enrollment data. This data will be combined with provider enrollment information NC Medicaid has on file to support the Prepaid Health Plans’ (PHPs’) ability to help determine which providers to contract with.
Please post an English and Spanish version of the “Notice Of Your Rights Under Hawkins v. Cohen” in a prominent location for at least 180 calendar days.
The Payment Error Rate Measurement (PERM) is an audit program developed and implemented by the Centers for Medicare & Medicaid Services (CMS) as required by the Improper Payments Information Act (IPIA) of 2002. It is used nationwide to review beneficiary eligibility determinations and claims payments made by North Carolina Medicaid and NC Health Choice to ensure that states only pay for appropriate claims. A national report is distributed outlining the various error rates among states.
New or amended clinical coverage policies are available on NC Medicaid’s website.
April is the last month to submit an attestation for Program Year 2018. The NC Medicaid EHR Incentive Payment System (NC-MIPS) will close for Program Year 2018 at midnight on Apr. 30, 2019. After that no changes can be made. Eligible professionals (EP) are strongly advised to review their attestation and documentation for accuracy and completeness
Beginning in April, participating health care providers in the state-designated health information exchange (HIE), NC HealthConnex, will be moving to a new HIE platform.
The State and GDIT are in the process of completing NCTracks system updates to provide notification on the Remittance Statement of adjustment actions taken on previously paid claims due to audits conducted by Third Party Recovery and the Office of Compliance and Program Integrity.