Blog Entry List
Note: This article was originally published as a Special Bulletin in January 2018, with updates regarding clinical pharmacist practitioners.
Providers must submit a Fingerprinting Criminal Background Check application within 30 days of receiving the request notification to avoid being terminated for cause.
In response to provider comments and questions regarding billing under the new federal Ordering, Prescribing and Referring (OPR) rules, North Carolina Medicaid is issuing this clarification for radiology and Independent Diagnostic Testing Facilities (IDTF).
In response to provider feedback, the use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will be extended from January 31, 2018 to April 30, 2018.
Clinical pharmacist practitioners will continue to use the NPI Exemption List until further notice.
The use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will cease on Jan. 31, 2018. Clinical Pharmacist Practitioners will continue to use the NPI Exemption List until further notice.
Flovent HFA Inhaler Moved to Preferred Status on the Preferred Drug List
Effective Feb. 3, 2017, Flovent HFA Inhaler has been moved to preferred status on the North Carolina Medicaid and NC Health Choice (NCHC) Preferred Drug List (PDL). This change is being made since Teva Pharmaceuticals has discontinued sales of QVAR Inhaler and to allow providers another preferred inhaled corticosteroid option.
The Special Medicaid Bulletin, Generic Dispensing Rate Adjustments and Flovent HFA Inhaler Moved to Preferred Status on the Preferred Drug List, had an incorrect date in the first sentence.
Here is the article with the correct information.
The NC Medicaid Electronic Health Record (EHR) Incentive Program is no longer accepting Program Year 2017 attestations.
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
1A-4, Cochlear and Auditory Brainstem Implants
1C-1, Podiatry Services
1K-1, Breast Imaging
1T-1, General Ophthalmological Services
These policies supersede previously published policies and procedures.
Clinical Policy and Programs
DMA, 919-855-4260
42 CFR 455.450 requires a state Medicaid agency to screen all initial provider applications based on a categorical risk level of “limited,” “moderate,” or “high.”
The NC Division of Medical Assistance (DMA) currently recognizes CPT Code 27216 (Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral).
In response to provider comments and questions regarding the December 2017 Special Bulletin, Billing Guidance:340B Modifiers, North Carolina Medicaid is publishing updated information regarding the use of the JG, TB and UD modifiers which are required to identify 340B drug claims.
The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Columbus County from the Eastpointe Local Management Entity – Managed Care Organization (LME-MCO) and their realignment with Trillium Health Resources LME-MCO.
Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography. Providers must submit claims with Healthcare Common Procedure Coding System (HCPCS) code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral) in addition to screening or diagnostic mammography Common Procedural Terminology (CPT) codes 77065-77067.
Clinical coverage policy 1K-1, Breast Imaging, is in the process of being updated to reflect the new coverage.
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries. Note: This article was originally published in February 2017 Medicaid Bulletin.