Blog Entry List
Registration is open for the August 2018 instructor-led provider training courses listed below. Slots are limited.
If a provider’s enrollment application or Manage Change Request (MCR) does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.
Medicaid has been made aware of reimbursement delays when claims for medical services are billed for inpatient services with a psychiatric diagnosis as the primary diagnosis.
Federal regulation 42 CFR 455.450 requires a state Medicaid agency to screen all initial provider applications based on a categorical risk level.
Fingerprinting is only required for high-risk providers as identified by 42 CFR 424.518(c), NC General Statute 108C-3g and Session Law 2018-5 SB99.
A list of providers scheduled for re-credentialing in 2018 is available on the Provider Enrollment Page of the North Carolina Medicaid website under the "Re-credentialing" header.
Effective July 1, 2018, CPT Code 95012, Fractional Exhaled Nitric Oxide (FENO) measurement, is approved in the assessment of pediatric beneficiaries with suspicion of asthma and for asthma management. Exhaled nitric oxide measurement is considered medically necessary and is covered when used as an adjunct with spirometry.
FENO measurement is considered medical necessary to:
Effective Aug. 1, 2018, North Carolina Medicaid will make a change to the N.C. Medicaid and N.C. Health Choice Preferred Drug List in the Antihyperkinesis/Attention Deficit Hyperactivity Disorder (ADHD) class.
As a reminder, providers are to request and obtain proper PA before services are scheduled or rendered. Contractually, CSRA (Medicaid’s fiscal vendor) has five business days (excluding holidays and weekends) to process a PA request once all required information is obtained.
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for the following CPT codes.
Effective May 1, 2018, North Carolina Medicaid began offering coverage of digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography using code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral).
Effective July 1, 2018, Cologuard (CPT code 81528) has been approved for colorectal cancer screening.
In accordance with the NC State Plan, Section 4.19-B, Section 3, Page 1, North Carolina Division of Medical Assistance (DMA) will revise rates for the following laboratory procedure codes: 81220, 81221, 81222, 81223, 81228, 81229, 81243, 81244, 81331, and 81507.
North Carolina Medicaid will reprocess Medicare Part B Crossover Professional and Outpatient claims submitted to Medicare from Jan. 2, 2017, to Jan. 5, 2017.
Medicare experienced a claims processing issue with claims submitted Jan. 2, 2017 to Jan. 5, 2017, causing incorrect reimbursement. Medicare performed a mass adjustment to correct the reimbursement of the affected claims. However, when the Medicare adjusted claims crossed over to Medicaid, NCTracks denied them in error. The system error that caused the denial of these Medicare adjusted claims has been resolved.
The following new or amended combined North Carolina and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.