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.
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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.
Effective March 1, 2018, all North Carolina Medicaid and NC Health Choice beneficiaries must be 12 years of age or older to receive chiropractic services.
Following a 45-day public comment period, Clinical Coverage Policy 3B, Program of All-Inclusive Care for the Elderly (PACE), was amended and posted on North Carolina Medicaid Community-Based Services Clinical Coverage Policy web page.
Effective March 1, 2018, North Carolina Medicaid has revised Clinical Policy 11C, Ventricular Assist Devices
In a recent attempt to send an email helping providers with a common error, CSRA noticed that 12.5 percent of the provider email addresses were invalid or unsubscribed. To provide providers with the accurate information they need, it is crucial that NCTracks has a valid email address that is subscribed to the NCTracks Communications email list. This is especially important for targeted emails that apply to specific providers (such as a claim reprocessing notice).
NCTracks encourages providers to:
Providers have until April 30, 2018, to submit a complete and accurate attestation for Program Year 2017 of the NC Electronic Health Record Incentive Program.
Registration is open for the March 2018 instructor-led provider training courses listed below. Slots are limited.