Blog Entry List
As a reminder, providers are to request and obtain proper prior authorization before services are scheduled or rendered. Contractually, GDIT has five business days (excluding holidays and weekends) to process a medical PA request once all required information is obtained. Pharmacy PAs are processed within 24 hours. Medical necessity cannot be determined with a partial or incomplete clinical picture.
There are only four months left to submit an attestation for Program Year 2018. Attestations submitted after Feb. 28, 2019 are not guaranteed to be reviewed by program staff prior to close of Program Year 2018. Providers have until April 30, 2019 to submit a complete and accurate attestation for Program Year 2018. After that no changes can be made.
Registration is open for the January 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection. Please note that the WebEx information has changed.
Clinical Coverage Policy 1N-2, Allergy Immunotherapy has been revised effective Jan. 1, 2019, to reflect changes in unit dosing.
Effective with date of service Jan. 1, 2019, the American Medical Association has added new CPT codes, deleted others and changed descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2019 edition of Current Procedural Terminology, published by the AMA.
Clinical Policy 1E-7, Family Planning Services, has been revised effective Jan. 1, 2019.
As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.
Proposed new or amended Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month. Visit Proposed Medicaid and NC Health Choice Policies for current posted policies and instructions to submit a comment.
NC Medicaid Clinical Policy, (919) 855-4260
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Nov. 1, 2018.
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for CPT codes 90791 – Psychiatric Diagnostic Evaluation and 90792 – Psychiatric Diagnostic Evaluation with Medical Servicess when provided via telemedicine/telepsychiatry.
Medicaid has designated specific ICD-10-CM diagnosis codes that do not count toward the annual visit limitation. These codes are reviewed regularly and updated as appropriate. The following ICD-10-CM codes will be added to this list of diagnosis codes for claims with dates of service on or after Jan. 1, 2019:
• F11.20 (OPIOID DEPENDENCE, UNCOMPLICATED)
• Z79.891 (LONG TERM [CURRENT] USE OF OPIATE ANALGESIC)
Visit NC Medicaid Annual Visit for more information.
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.
Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.
The Money Follows the Person Demonstration Project (MFP) team is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year. MFP will continue to transition individuals on Medicaid from skilled level, long-term care facilities back to the community until all populations are folded into Medicaid Managed Care. The new application will be effective for participation requests starting Jan. 1, 2019, and will be available on the MFP website after Dec. 1, 2018.
In response to the anticipated higher than normal number of influenza cases this coming season, effective December 1, 2018, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms. The purpose of this service is to assist primary care providers assessing established patients over the telephone to gather additional information.
Proposed Clinical Coverage Policies for Public Comment
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.
As of Nov. 1, 2018, the following NC Medicaid policies are open for public comment: