Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit the Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.
Blog Entry List
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Aug. 31, 2018.
North Carolina health care providers are required by law to connect with NC HealthConnex, North Carolina’s designated health information exchange.
Per the updated IPPS Final Rule released Aug. 2, 2018, the EHR reporting period will now be referred to as the Promoting Interoperability (PI) reporting period.
Registration is open for several instructor-led training courses for providers that will be held in October 2018.
In April 2018, the recredentialing notification and suspension process was modified. The previous rule to extend the recredentialing due date if a Manage Change Request Application is "In Review" has been removed.
Pursuant to Section 6.a. of the NCDHHS Provider Administrative Participation Agreement, providers are required to update their enrollment records in NCTracks within 30 days of a change.
If a provider’s enrollment application or Manage Change Request (MCR) does not contain errors, it will process more quickly. NC Medicaid and the NCTracks Enrollment Team frequently share information about commons errors that cause delays in processing applications and MCRs.
The 2019 ICD-10 update is effective Oct. 1, 2018 through Sept. 30, 2019, for provider use.
Claims for balloon sinus ostial dilation billed with modifier 50 (bilateral) have been resulting in an underpayment to providers. The issue has been resolved.
Effective with date of service Sept. 5, 2018, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant) PEGylated-aucl, for intravenous use (Jivi) for use in the Physician's Drug Program (PDP) when billed with HCPCS code J7199-Hemophilia clotting factor, not otherwise classified.
Effective with date of service Sept. 5, 2018, the Medicaid and NC Health Choice programs cover patisiran lipid complex injection, for intravenous use (Onpattro) for use in the Physicians Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Aug. 17, 2018, the Medicaid and NC Health Choice programs cover plazomicin injection, for intravenous use (Zemdri) for use in the Physician's Drug Program when billed with HCPCS code J3490-Unclassified drugs.
Providers are reminded that NC Medicaid flexibilities due to Hurricane Florence end on Oct. 5, 2018. For additional information, please refer to the Sept. 27, 2018 Special Medicaid Bulletin.
NCTracks Call Center, 1-800-688-6696
NC Medicaid and Health Choice will reimburse providers for medically necessary drugs and services and equipment and supplies provided during the Hurricane Florence emergency without prior approval from Sept. 14 through Oct. 5, 2018.