This article was updated on May 10, 2018. Topics include: list of providers due for re-credentialing, changes to re-credentialing process, and changes to ongoing verification process.
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The Payment Error Rate Measurement (PERM) audit calculates error rates for Medicaid, Children’s Health Insurance Programs (CHIP) and Managed Care on a three-year cycle for the Centers for Medicare & Medicaid Services (CMS). The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of those three programs in the fiscal year under review.
Note: NC Health Choice (NCHC) is the state’s CHIP program.
This article assists providers to identify and report potential report fraud, waste, or abuse.
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 Jan. 31, 2018 to April 30, 2018. Note: This article was originally published as a Special Bulletin in January 2018.
Effective April 1, 2018, North Carolina Medicaid will make several changes to the Medicaid and NC Health Choice Preferred Drug List (PDL):
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 following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on North Carolina Medicaid’s Clinical Coverage Policy web pages.
If a provider’s enrollment application or Manage Change Request (MCR) is clean and does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.
Providers have until April 30, 2018, to submit a complete and accurate attestation for Program Year 2017.
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.