This is a reminder that not all drugs administered by injection or infusion are covered in the Physicians Drug Program (PDP) as a part of the medical benefit. Some of these drugs are only covered in the outpatient pharmacy benefit when requested by prior authorization (PA) and dispensed by a retail or specialty pharmacy.
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NC Medicaid has approved the release of a Request for Proposal (RFP) for an independent assessment entity (IAE) that will streamline access to Medicaid Long-Term Services and Supports (LTSS) effective July 2019. The IAE will provide beneficiaries a much-needed single point of entry for accessing Medicaid LTSS services and streamline the processes between initial contact and service enrollment.
There are only three months left to submit an attestation for Program Year 2018. Providers have until Apr. 30, 2019 to submit a complete and accurate attestation for Program Year 2018.
Registration is open for the February 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.
NC Medicaid has completed updating endoscopy codes in NCTracks, aligning base codes with related procedures in the same family as well as creating three new endoscopy families in NCTracks.
Effective Jan. 27, 2019, abandoned applications are subject to new rules in NCTracks. While the process for addressing incomplete applications will not change, the timeframes allowed for the submission of documentation are revised.
There has been some confusion over the difference between the currently enrolled provider (CEP) registration and the office administrator (OA) change process. To understand which you may need to use, please see the explanations below.
The following new or amended clinical coverage policies are available on NC Medicaid’s website. These policies supersede previously published policies and procedures.
A contract has been awarded to Wipro Infocrossing to serve as the Provider Data Contractor (PDC), as NC Medicaid transitions to Managed Care. Wipro Infocrossing, will assist the North Carolina Medicaid Managed Care program to identify the credentialing status of providers contracting with Prepaid Health Plans (PHPs).
The following new or amended clinical coverage policies are available on NC Medicaid’s clinical coverage policies web page:
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.