Blog Entry List
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries.
Registration is open for the February 2018 instructor-led provider training courses listed below. Slots are limited.
Facility providers can now access Sterilization Consent Form status, including denial reasons, on the secure NCTracks Provider Portal.
Effective April 1, 2018, when performing a wet mount screening, providers serving Family Planning Medicaid (MAFDN) beneficiaries shall bill procedure code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]). If both saline and potassium hydroxide (KOH) methods are needed, two units may be billed. Wet mount screenings may be performed during the annual exam or during any of the six inter-periodic visits allowed per 365 days under Family Planning Medicaid, when a sexually transmitted screening is required.
At various times of the year, Medicaid providers may receive notification of participation letters from the DMA Office of Compliance and Program Integrity which facilitates audits from various auditing agencies, e.g. Office of the Inspector General, Office of Internal Auditor, and Office of State Auditor.
This email is an update to yesterday’s email and previous North Carolina Medicaid Bulletins. 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.
Note: This article was previously published in the September 2017 Medicaid Bulletin. It is being republished with updates.
Effective Feb. 1, 2018, N.C. Medicaid will cover balloon sinus ostial dilatation (BOD) surgery. The BOD policy will outline the new coverage for applicable CPT procedure codes.
The American Medical Association (AMA) publishes an annual Current Procedural Terminology (CPT) manual each fall outlining new, revised, and deleted procedural codes effective January 1 of the following calendar year. (For complete information regarding all code and description changes, refer to the 2018 edition of Current Procedural Terminology.) N.C. Medicaid reviews these codes changes to determine clinical coverage for the Medicaid program.
Effective Oct. 29, 2017, NCTracks will implement a quarterly Maintain Eligibility Process which identifies providers with no claim activity within the past 12 months. The provider must attest electronically in NCTracks to remain active.
The Centers for Medicare & Medicaid Services announced an increase in the Affordable Care Act provider enrollment application fee.
The N.C. Medicaid and N.C. Health Choice (NCHC) application fee is $100, which covers costs associated with processing enrollment applications. The $100 application fee is required for both in-state and border-area (within 40 miles) providers during initial enrollment and when providers complete the five-year reverification process.
The provision of family planning services and family planning-related services has been the sole purpose of the “Be Smart” Family Planning Medicaid program since it started in October 2005, and continued with the CMS approval of the State Plan Amendment in 2014.
Appropriate maternal depression screening is necessary to ensure that postpartum depression is addressed and care is administered in a timely manner to improve quality of care and long-term outcomes for both mother and child. Maternal depression screening identifies mothers who may be suffering from depression and may lead to treatment or discussion of referral strategies for appropriate treatment.
The following new or amended combined N.C. Medicaid and N.C. Health Choice clinical coverage policies are available on DMA’s clinical coverage policy web pages.