Blog Entry List
Effective May 1, 2018, Clinical Coverage Policy 1C-1, Podiatry Services, is revised to include annual updates to International Classification of Diseases (ICD-10-CM) codes.
The implementation of ICD-10-CM allows specificity for accurate coding, resulting in greater justification of medical necessity. A provider’s documentation must include details to completely depict the nature of a beneficiary’s diagnosis and procedures performed.
Note: This article was previously published in the September 2017 Medicaid Bulletin. It is republished with updates regarding edit disposition.
Effective Oct. 29, 2017, the NC Department of Health and Human Services (DHHS) validates through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider address, city, state and zip code (first five digits) on all North Carolina Medicaid and NC Health Choice claims must match exactly with the corresponding information on
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for Medicaid and NCHC services.
By July 1, 2018, Medicaid behavioral health providers added to NCTracks by their current Local Management Entity/Managed Care Organization Provider Upload Process must complete re-verification.
Topics include: list of providers due for re-credentialing, changes to re-credentialing process and changes to ongoing verification process.
Effective Feb. 1, 2018, Clinical Coverage Policy 1A-42, Balloon Ostial Dilation, was revised to include new coverage of CPT code 31298 (balloon dilation of frontal and sphenoid sinus). North Carolina Medicaid will cover this procedure or one of the other Balloon Ostial Dilation (BOD) procedures once per sinus during the beneficiary’s lifetime.
Prior approval for this procedure is required.
In accordance with 10A NCAC 22J .0106, a provider may refuse to accept a patient as a Medicaid patient and bill the patient as a private pay patient only if the provider informs the patient that the provider will not bill Medicaid for any services, but will charge the patient for all services provided.
April is the last month to submit an attestation for the NC Medicaid Electronic Health Record Incentive Program for Program Year 2017. North Carolina’s Medicaid EHR Incentive Payment System will close for Program Year 2017 at midnight on April 30, 2018.
The following new or amended combined North Carolina Medicaid and NC Health Choice (NCHC) clinical coverage policies are available on Medicaid’s clinical coverage policy web pages.
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for North Carolina Medicaid and NC Health Choice services.
Every year, in accordance with 2 CFR part 200, subpart F, the NC Office of the State Auditor selects a sample of North Carolina Medicaid and NC Health Choice claims to review to determine the state’s compliance with federal and state regulations for claims paid in the prior state fiscal year, which runs from July 1 to June 30.
Changes to two clinical coverage policies – 2A-1, Acute Inpatient Hospital Services and 1A-4, Cochlear and Auditory Brainstem Implants – will soon become effective.
Registration is open for the April 2018 instructor-led provider training course and annual seminar listed below. Slots are limited.
On April 29, 2018, a new reimbursement methodology will be implemented for medical claims for physician-administered Long Acting Reversible Contraceptives and vaccines, effective for claims with date of service July 1, 2017 and after.